Clinical Challenges in Surgical Palliative Care: Malignant Bowel Obstruction

Welcome to the third of a six-part series focused on the integration of palliative care into the practice of surgery. Malignant bowel obstructions occur in 5-43 percent of patients with a diagnosis of advanced primary or metastatic intra-abdominal malignancy and both acute care surgeons and surgical oncologists are called upon to manage this condition. Using the case of an elderly gentleman with gastric outlet obstruction secondary to gastric cancer, in this episode we discuss how to approach a patient with a malignant bowel obstruction, review the medical and surgical options for management, discuss the importance of primary palliative care, define palliative surgery and conclude with a short rant about the necessity of being cognizant of one’s feelings and of taking the time and creating the space to discuss them. Fast Fact #45: Medical Management of Bowel Obstructions https://www.mypcnow.org/fast-fact/medical-management-of-bowel-obstructions/ Chapter 8, Malignant Bowel Obstruction in Surgical Palliative Care: A Resident’s Guide https://www.facs.org/~/media/files/education/palliativecare/surgicalpalliativecareresidents.ashx Palliative surgery and the surgeon’s role in the palliative care team: a review. https://apm.amegroups.com/article/download/72758/pdf Dr. Red Hoffman (@redmdnd) is an acute care surgeon and associate hospice medical director in Asheville, North Carolina, host of the Surgical Palliative Care Podcast (@surgpallcare) and co-founder of the recently launched Surgical Palliative Care Society ( www.spcsociety.org ). Dr. Fabian Johnston (@fabianjohnston) is Associate Professor of Surgery and Oncology and Chief, Division of GI Surgical Oncology at Johns Hopkins University. Dr. Amanda Stastny (@manda_plez) is a PGY-2 in the General Surgery program at Mountain Area Health Education Center (MAHEC) in Asheville, NC. Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.