Pathophysiology

• Obstruction leads to proximal dilatation.
• Dilatation leads to stretching of gut wall.
• Stretching of gut wall leads to increased secretion.
• Increased secretion exacerbates dilatation.
• Relatively rare in children.
• May occur with abdominal tumours such as neuroblastoma or where there is abdominal extension of pelvic tumours.

Signs and symptoms

• Nausea and vomiting.
• Constipation.
• Severe intermittent colicky abdominal pain.
• Abdominal dilation.
• Usually occurring in context of known abdominal tumour.

Management

• Surgery sometimes an option if single discrete obstruction.
• Reduce spasm (anticholinergics e.g. Buscopan).
• Strong opioid analgesia (e.g. Diamorphine).
• Antiemetics (e.g. Haloperidol).
• Reduce secretions (reduce fluid intake, nil by mouth, consider Octreotide).
• Consider prokinetics (e.g. Metaclopromide) if obstruction is not complete, such that there is the possibility of spontaneous resolution.  In the event of complete obstruction Metaclopromide may exacerbate colic and should be discontinued.
• Consdier steroids to reduce tumour oedema.

NB  Prokinetics and anticholinergics are mutually inhibitory and should not usually be used together.  As many as half of all episodes of intestinal obstruction associated with malignant disease may resolve spontaneously without the need for surgical intervention.