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BMC Research Notes

Open Access

Postpyloric decompression tube placement through a gastrostomy for malignant bowel obstruction

  • Yusuke Kurita1,
  • Tomoko Koide1,
  • Seitaro Watanabe1,
  • Tatsuya Ogawa1,
  • Yusuke Sekino1,
  • Hiroshi Iida1,
  • Takashi Nonaka1,
  • Akihiko Kusakabe1,
  • Eiji Gotoh2,
  • Shin Maeda1,
  • Atsushi Nakajima1 and
  • Masahiko Inamori1Email author
BMC Research Notes20136:217

https://doi.org/10.1186/1756-0500-6-217

Received: 21 December 2012

Accepted: 23 May 2013

Published: 3 June 2013

Abstract

Background

Malignant bowel obstruction affect a patient’s quality of life, but, management of MBO is controversial.

Case presentation

A 51-year-old woman who had been diagnosed as uterine cervix cancer 2 years ago and had undergone surgery, chemotherapy and radiotherapy, was admitted to our hospital. She was diagnosed as having a recurrence of peritoneal metastasis and bowel obstruction. For her nasal pain, we considered insertion of a postpyloric decompression tube through the gastrostomy instead of via the nasal cavity. After insertion of a percutaneous gastrostomy tube was performed endoscopically, we introduced a postpyloric decompression tube through her gastrostomy. She could be discharged home, and 91 days later, she died in her home under hospice care, as she had wished.

Conclusions

Insertion of a postpyloric decompression tube through a gastrostomy might be useful in the management of advanced cancer patients with bowel obstruction.

Keywords

Malignant bowel obstructionGastrostomyPalliative careQuality of life

Background

Malignant bowel obstruction (MBO), a common complication in patients with advanced cancer, can significantly affect a patient’s quality of life [13]. However, management of MBO is controversial [46].

Case presentation

A 51-year-old woman who had been diagnosed as having stage 2b uterine cervix cancer 2 years ago and had undergone surgery, chemotherapy and radiotherapy, was admitted to our hospital with nausea and abdominal pain. She was diagnosed as having a recurrence of peritoneal metastasis with complicating ascites and bowel obstruction. We first treated her conservatively however, a month later, her symptoms recurred and a postpyloric decompression tube was introduced via the nasal cavity. After the procedure, she complained of severe nasal pain and expressed her wish for treatment by a different method.

We therefore considered insertion of a postpyloric decompression tube through the gastrostomy instead of via the nasal cavity. Following obtainment of informed consent, insertion of a percutaneous gastrostomy tube was performed endoscopically (Figure 1). Two weeks later, we introduced a postpyloric decompression tube through her gastrostomy instead of via the nasal cavity. The postpyloric decompression was effective (Figure 2), she was discharged home, and 91 days later, she died in her home under hospice care, as she had wished.
Figure 1

Percutaneous gastrostomy tube insertion was performed endoscopically, while a transnasal postpyloric decompression tube was present in her stomach.

Figure 2

Postpyloric decompression tube was inserted through the gastrostomy.

Conclusions

Palliation of symptoms is the treatment goal terminal disease patients with MBO. Hospitalization and conservative management by nasogastric tube decompression and bowel rest is the first step in the management of MBO. However, when continuous postpyloric decompression is required, insertion of the postpyloric decompression tube through the gastrostomy instead of via the nasal cavity may be a reasonable approach, especially in patients hesitating to undergo tube placement via the conventional nasal approach and/or in gynecologic malignancies patients who are not good surgical candidates.

In conclusion, insertion of a postpyloric decompression tube through a gastrostomy might be useful in the management of advanced cancer patients with bowel obstruction.

Consent

Written informed consent was obtained from the patient and her family for publication of this Case report and any accompanying images. A copy of the written consent is available for review by the Editor of this journal.

Declarations

Acknowledgements

Special thanks to medical staff of Yokohama City University Hospital.

Authors’ Affiliations

(1)
Gastroenterology Division, Yokohama City University Hospital
(2)
Department of Medical Education, Yokohama City University School of Medicine

References

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Copyright

© Kurita et al.; licensee BioMed Central Ltd. 2013

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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