Small bowel obstruction

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Sara!!!!
Posts: 51
Joined: Wed Jul 19, 2017 9:57 am

Small bowel obstruction

Postby Sara!!!! » Thu Jan 25, 2018 8:42 am

Hey everyone. My mom has stage 4 colon cancer with mets to liver, lungs, peritoneum. For the past few days she has been having intermittent vomiting and diarrhea. CT scan showed obstruction in ileum due to mets in omentum. Has anyone had small bowel obstruction? They are treating it conservatively now but there's a high chance it won't resolve. She can't undergo surgery due to too much spread. What are we gona do?? :( :(
Daughter to mom 67, colon cancer
Diagnosed Dec 16, bowel obstruction.
Hemicolectimy done,Dec 16.
4 lesions in liver on scan before chemo jan 17.
Folfox +Avastin 12 cycles,disease progression on pet Aug 17.
Attempted liver resection, failed. Mets peritoneam. Diffuse.
Mets to lungs, liver. Peri on scan Nov 17.
3 cycles of folfiri+ cetuximab. Cea down from 888 to 383.
Small bowel obstruction jan 18

ilovemyfrenchie
Posts: 23
Joined: Fri Nov 03, 2017 9:20 pm

Re: Small bowel obstruction

Postby ilovemyfrenchie » Thu Jan 25, 2018 11:06 am

From my understanding for bowel obstruction the first treatment for anyone is to keep them on bowel rest meaning nothing by mouth (no food or water) and they insert an NG tube to suck out any bile or fluid that is not moving through the GI tract, hence the vomiting. They leave the tube in to help the nausea and vomiting. Then in the mean time they consult a surgeon which in your case they won’t operative. But a lot of people are treated conservatively and it’s something unfortunately they have to treat day by day and see if it resolves. It can takes days to weeks.

Can you add a signature/history about your mother? My mother has similar Mets but this journey has just begun for us.
Daughter to 59 yo w/ Stage 4 Mets to liver & peritoneal
10/1/17 ER trip for GI bleed found rectal tumor (CEA 71)
10/2/17 emergency colostomy (no resection, told tumor inoperable due to Mets found)
10/17 started Folfiri with Avastin (CEA 171)
8/18 CT = liver Mets continue to shrink (CEA 4)

“Chemo for life” hoping for surgery soon

Sara!!!!
Posts: 51
Joined: Wed Jul 19, 2017 9:57 am

Re: Small bowel obstruction

Postby Sara!!!! » Thu Jan 25, 2018 12:06 pm

ilovemyfrenchie wrote:From my understanding for bowel obstruction the first treatment for anyone is to keep them on bowel rest meaning nothing by mouth (no food or water) and they insert an NG tube to suck out any bile or fluid that is not moving through the GI tract, hence the vomiting. They leave the tube in to help the nausea and vomiting. Then in the mean time they consult a surgeon which in your case they won’t operative. But a lot of people are treated conservatively and it’s something unfortunately they have to treat day by day and see if it resolves. It can takes days to weeks.

Can you add a signature/history about your mother? My mother has similar Mets but this journey has just begun for us.

Yeah they're trying to treat it conservatively but they say it's blocked on more than one place (ileum) so it most probably won't resolve. I'm soooo worried. I hope, just hope it will. We were so happy after the cea started going down. N now this :(
Daughter to mom 67, colon cancer
Diagnosed Dec 16, bowel obstruction.
Hemicolectimy done,Dec 16.
4 lesions in liver on scan before chemo jan 17.
Folfox +Avastin 12 cycles,disease progression on pet Aug 17.
Attempted liver resection, failed. Mets peritoneam. Diffuse.
Mets to lungs, liver. Peri on scan Nov 17.
3 cycles of folfiri+ cetuximab. Cea down from 888 to 383.
Small bowel obstruction jan 18

User avatar
GrouseMan
Posts: 888
Joined: Mon Aug 12, 2013 12:30 pm
Location: SE Michigan USA

Re: Small bowel obstruction

Postby GrouseMan » Fri Jan 26, 2018 12:00 pm

Sara

What you are describing was in my wife's case the beginning of the end for her. They attempted to bypass the blockage by giving her a colostomy. That seemed to help for a few days, but there appeared to be a second blockage above where they made the colostomy connection. She had quite a lot of bile production and was throwing up several liters of green liquid a day. So we tried a stomach tube as she didn't like the ng tube very much. But in the end - the blockage really prevented her from taking in any nourishment or fluids. She basically withered away. All we could do was try and keep her comfortable with painkillers. I lost her last June after a 4 year battle with Stage IV colon cancer.

I am sorry for your mothers condition. I wish everyone's Colon Cancer could be discovered at a much earlier stage. But sometimes we get fooled. My wife was very athletic and was training for a marathon at the time of diagnosis. She was a life time runner with habits from running Track and Cross Country in HS. Doctor didn't insist hard enough at age 50 to get the colonoscopy. Had she done so they would have caught it 3 years earlier perhaps before it spread.

GrouseMan
DW 53 dx Jun 2013
CT mets Liver Spleen lung. IVb CEA~110
Jul 2013 Sig Resct
8/13 FolFox,Avastin 12Tx mild sfx, Ongoing 5-FU Avastin every 3 wks.
CEA: good marker
7/7/14 CT Can't see the spleen Mets.
8/16/15 CEA Up, CT new abdominal mets. Iri, 5-FU, Avastin every 2 wks.
1/16 Iri, Erbitux and likely Avastin (Trial) CEA going >.
1/17 CEA up again dropped from Trial, Mets growth 4-6 mm in abdomen
5/2/17 Failed second trial, Hospitalized 15 days 5/11. Home Hospice 5/26, at peace 6/4/2017

Sara!!!!
Posts: 51
Joined: Wed Jul 19, 2017 9:57 am

Re: Small bowel obstruction

Postby Sara!!!! » Fri Jan 26, 2018 12:32 pm

GrouseMan wrote:Sara

What you are describing was in my wife's case the beginning of the end for her. They attempted to bypass the blockage by giving her a colostomy. That seemed to help for a few days, but there appeared to be a second blockage above where they made the colostomy connection. She had quite a lot of bile production and was throwing up several liters of green liquid a day. So we tried a stomach tube as she didn't like the ng tube very much. But in the end - the blockage really prevented her from taking in any nourishment or fluids. She basically withered away. All we could do was try and keep her comfortable with painkillers. I lost her last June after a 4 year battle with Stage IV colon cancer.

I am sorry for your mothers condition. I wish everyone's Colon Cancer could be discovered at a much earlier stage. But sometimes we get fooled. My wife was very athletic and was training for a marathon at the time of diagnosis. She was a life time runner with habits from running Track and Cross Country in HS. Doctor didn't insist hard enough at age 50 to get the colonoscopy. Had she done so they would have caught it 3 years earlier perhaps before it spread.

GrouseMan

Omg.. our mom means everything to us. It's literally killing us.
Daughter to mom 67, colon cancer
Diagnosed Dec 16, bowel obstruction.
Hemicolectimy done,Dec 16.
4 lesions in liver on scan before chemo jan 17.
Folfox +Avastin 12 cycles,disease progression on pet Aug 17.
Attempted liver resection, failed. Mets peritoneam. Diffuse.
Mets to lungs, liver. Peri on scan Nov 17.
3 cycles of folfiri+ cetuximab. Cea down from 888 to 383.
Small bowel obstruction jan 18

risto
Posts: 54
Joined: Wed Jan 06, 2016 2:28 am
Location: USA

Re: Small bowel obstruction

Postby risto » Fri Jan 26, 2018 9:46 pm

Sara, if your mom is not going to be able to eat, there is the option of total parenteral nutrition.
https://en.wikipedia.org/wiki/Parenteral_nutrition

This may or may not be advantageous depending on other factors, but if she has good performance status and decent vital signs it may be worth a try. People can live months or longer on TPN in some cases. Though there is a risk of infection or other serious issues, the certainty of starvation without eating would definitely make me want my wife to try this option if her SBO does not clear up.

From what I gather, TPN is not recommended if the patient is near end of life anyway, and often SBO if it is caused by malignancy (as opposed to adhesion) is an indicator of that.
DW Dx 7/15, 41 yo, st IV, 3+ liver mets: 11.3 cm, 7cm, 3cm. MSS.
KRAS, APC, SMAD4, TP53 mut.
7/15-10/15: FOLFOX+bev. x8
11/15-12/15: SIRT (Y90)
1/16: Toxic Hepatitis, chemo break
4/16: Liver resec. fail
5/16-7/16: FOLFIRI x6
8/16: Liver resec.
8/16-11/16: FOLFIRI x6
2/17: IMRT/Xeloda x25
4/17: LAR
6/17: CT: Progression. Peri, Lung, Liver mets. FOLFIRI x6
9/17: FOLFIRI+Bev x5.
11/17: CT: Stable. 5FU+bev. maintenance x5
1/18-2/18: Surgery for SBO
5/18: ascites, acute liver injury


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