Bowel-Related Odors at End of Life

Clinical Conditions That Cause Bowel-Related Odors

• When perforation occurs proximal to a tumor site, fecal spread results in diffuse peritonitis, which can produce a characteristic fecal odor from peritoneal contamination, typically presenting with fever, tachycardia, and an acutely ill appearance with diffuse abdominal tenderness, as noted by the World Journal of Emergency Surgery 1
• Fecal impaction can lead to overflow diarrhea with associated odor, and digital rectal examination may reveal impacted feces or complete absence of stool, according to the Annals of Oncology 2
• Loss of bowel control occurs in approximately 16% of patients without a stoma after colorectal cancer treatment, as reported in Gut 3

Assessment and Management

• Abdominal examination for distension, masses, tenderness, and bowel sounds should be performed to identify obstruction or perforation, as recommended by the World Journal of Emergency Surgery and Annals of Oncology 1, 2
• Digital rectal examination should be conducted to assess for impaction, masses, or blood, according to the Annals of Oncology 2
• Signs of peritonitis, including fever, rebound tenderness, and absent bowel sounds, should be evaluated if fecal odor is prominent, as noted by the World Journal of Emergency Surgery 1
• CT scan is the preferred diagnostic method for confirming malignant bowel obstruction, achieving better results than ultrasound or plain X-ray, as reported by the World Journal of Emergency Surgery 1
• A bowel regimen with stimulant or osmotic laxative should be instituted in all patients receiving sustained opioid administration, unless contraindicated, as recommended by Intensive Care Medicine 4