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Case Reports: Novel treatment (new drug/interventions; established drug/procedure in new situation)
Epidural pain management in advanced gastric cancer with inoperable malignant bowel obstruction
  1. Riley Bohan1,
  2. Jeffery Budweg1,
  3. Stephen Vose2 and
  4. Mircea Sorin1
  1. 1Internal Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
  2. 2Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
  1. Correspondence to Riley Bohan; rbohan1{at}ufl.edu

Abstract

Presented is a case of a man in his 20s with gastric cancer with metastasis to a perineal nodule and the splenic flexure (previously resected due to acute bowel obstruction) who presented with prolonged, intermittent, inoperable bowel obstruction likely due to adhesions, exacerbated by functional ileus due to substantial opioid requirement. In an episode of obstruction during the described admission, the patient remained obstructed after more than 10 days of medical management. The patient suffered from intense abdominal distention and pain, necessitating hundreds of oral morphine equivalents daily. A ropivacaine thoracic epidural infusion was initiated, allowing decreased opioid use and relief of opioid-induced ileus contributing to his bowel obstruction. He subsequently had multiple formed bowel movements, which quickly decreased the patient’s abdominal distention and immediate risk of perforation. This case explores epidurals as an underutilised approach to pain management in metastatic gastric malignancy and inoperable malignant bowel obstructions.

  • Pain
  • Gastrointestinal system
  • Gastric cancer
  • Palliative procedures
  • Small intestine

https://doi.org/10.1136/bcr-2022-253665

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    Footnotes

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: RB, JB, SV, MS. The following authors gave final approval of the manuscript: RB, JB, SV, MS.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.