Surgical management of malignant bowel obstruction in recurrent pancreatic cancer

Abstract

INTRODUCTION : Malignant bowel obstruction (MBO) is harrowing complication of gastrointestinal cancers. Only a few studies have reported on the surgical roles of bowel obstruction from recurrent pancreatic cancer. We report successfully management for malignant bowel obstruction by palliative surgery for relief of symptoms.

PRESENTATION OF CASE : A 43 year old man was diagnosed with pancreatic tail cancer. After distal pancreatectomy, he underwent six cycle of adjuvant chemotherapy. 10 months later, he had suffered from small bowel obstruction by seeding metastases. We performed segmental small bowel resection. This patient had good recovery and continued to receive palliative chemotherapy. A 78 year old man was diagnosed with unresectable, huge pancreatic cancer. He had recurrent obstructive symptoms and periumbilical pain. We decided palliative surgery of wide excision of umbilical abdominal mass for pain control. 3 weeks later, he presented with recurrent symptoms in previous op site. We planned 2nd operation for relief of symptoms. He underwent surgery to resect abdominal wall mass and small bowel due to 2cm sized mass in terminal ileum. After 2nd surgery, he received consistently palliative chemotherapy with good clinical condition.

DISCUSSION AND CONCLUSION : Palliative surgery improves quality of life in recurrent pancreatic cancer patients and can continue patient's palliative management. In selected patients, palliative surgery may effective management for progress of survival and quality of life.