Small Bowel Obstruction in Patients with a Prior History of gastriontestinal Malignancies

Hong, Boo Whan; Jung, Suk In; Jung, Ki Hoon; Mok, Young Jae; Whang, Cheung Wung

Abstract

Surgeons are often faced with the problem of bowel obstruction in a patient who has previously undergone operation for malignant disease. Mechanical obstruction secondary to recurrent carcinoma is associated with poor survival. Surgical attempts to relieve malignant obstruction have significant morbidity and mortality rates and limited success in resolving symptoms. Then there is a temptation to assume that the obstruction is due to advanced malignancy and that death is inevitable. But a benign, correctable cause of obstruction will be found in about 25% of these patients. For this study, we had selected 63 cases of small bowel obstruction in patients with a previous operation for cancer which were admitted at Korea University Hospital between 1990 to 1995. The 43 men and 20 women had a mean age of 55.5 years. Forty one cases(65%) had obstruction due to recurrent carcinoma. The location of primary malignancies were as follows: 47 of the patients(74.6%) had adenocarcinoma of the stomach, 16 patients(25.4%) had adenocarcinoma of the colorectum. The median interval from the original operation for the malignancies until the development of bowel obstruction was 17.5 months. In our study, the small bowel obstruction due to recurrent carcinoma was frequently predicted when ascites and pleural effusion were present. We concluded that patients with no known recurrence or a short interval to the development of mechanical obstruction should be aggressively treated with surgery and for patients with known abdominal recurrence in whom nonoperative therapy fail, the surgical palliation are inevitable.