# Malignant bowel obstruction in advanced cancer: medicines, decompression, stents, surgery and nutrition

Source: https://onco.cc/protocols/malignant-bowel-obstruction/  
OnCo record `malignant-bowel-obstruction` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Advanced bowel, ovarian or other abdominal cancer can block the bowel. Cramping pain, a swollen tummy, being sick and not passing wind or stools need urgent assessment; a CT scan confirms it. Treatment depends on what you want from care and how well you are: some people have a stent or an operation, many have medicines for sickness and pain, sometimes with a tube to drain the stomach.

## Summary

MASCC 2022 is the most complete recent guideline: a systematic review to March 2021 producing 25 graded suggestions and recommendations (MASCC levels I to V and grades A to D). MBO is a clinical diagnosis confirmed by contrast CT, which is more valuable than plain X-ray. Decisions are framed by goals of care, prognosis, performance status and where care is given, and a surgical opinion should be considered at diagnosis.

Medicines: a somatostatin analogue (octreotide, lanreotide) is the only recommendation at level I, grade A (to reduce vomiting); MASCC 2021 calls octreotide the drug of choice in non-operable MBO. Haloperidol is suggested, particularly in complete obstruction (IV, B); metoclopramide or domperidone in partial obstruction only, avoided in complete obstruction because of perforation risk (III, B); steroids for short-term benefit (III, B), dexamethasone 4 to 16 mg daily, with discontinuation considered after 3 to 5 days without benefit; hyoscine butylbromide is probably inferior to octreotide for vomiting (III, D); opioids are standard for pain without trial evidence (V, D); osmotic laxatives only in partial obstruction.

Decompression and procedures: nasogastric tube for temporary decompression (V, D); endoscopic or percutaneous venting gastrostomy (IV, B); self-expanding metal stents preferred for single-level large bowel obstruction without perforation (II, B); palliative surgery for multi-level obstruction only in highly selected people (IV, B), given high complication rates. Nutrition: nil by mouth at first, then a slow, symptom-led reintroduction of a low-fibre diet (IV, B); parenteral hydration does not relieve thirst or dry mouth and is not started routinely in the last days of life (III, B); home parenteral nutrition only for a very selected group (IV, D).

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: MBO; bowel obstruction in advanced cancer; inoperable bowel obstruction; octreotide for bowel obstruction; venting gastrostomy
- Tags: protocol; acute-oncology; oncological-emergency; palliative

## Connected records

- cancers: [Colorectal cancer](https://onco.cc/cancers/colorectal/), [Ovarian cancer](https://onco.cc/cancers/ovarian/)
- technologies: [CT (computed tomography)](https://onco.cc/technologies/ct/), [Early integrated palliative care](https://onco.cc/technologies/palliative-care/), [Enteral and parenteral nutrition support](https://onco.cc/technologies/enteral-parenteral-nutrition/), [Self-expanding metal stents for malignant obstruction (oesophagus, duodenum, colon, bile duct, airway)](https://onco.cc/technologies/self-expanding-metal-stents/)
- drugs: [Dexamethasone](https://onco.cc/drugs/dexamethasone/), [Somatostatin analogues (octreotide, lanreotide)](https://onco.cc/drugs/octreotide-lanreotide/)
- institutions: [Multinational Association of Supportive Care in Cancer](https://onco.cc/institutions/mascc/)
- terms: [Feeding tube (gastrostomy, PEG, jejunostomy)](https://onco.cc/terms/feeding-tube/), [Palliation in colorectal cancer: obstruction, stents, stomas and liver capsule pain](https://onco.cc/terms/colorectal-palliation-obstruction-pain/)

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