Obstrucción intestinal secundaria a carcinomatosis peritoneal. Estudio descriptivo de 98 episodios

Objective: to describe the evolution of patients with malignant bowel obstruction due to peritoneal carcinomatosis since diagnosis until death; to analyze survival of these patients, to demonstrate the relationship between some laboratory tests and prognosis, to detect problems that worsen quality of life, to review treatment received, and to collect place of death. Material and method: a descriptive study. We retrospectively reviewed inpatients diagnosed with malignant bowel obstruction due to peritoneal carcinomatosis at the Palliative Care Unit in University Hospital Severo Ochoa (Leganes, Madrid) between 2002 and 2008. Variables we analyzed included: age, sex, etiology of tumor, symptoms and treatments during admission to hospital, hemoglobin and albumin levels at admission, time between tumor diagnosis and death, time between first episode of malignant bowel obstruction and death, and place where these patients die. Results: we reviewed 98 cases of malignant bowel obstruction due to peritoneal carcinomatosis in 72 patients. Twenty patients were admitted to hospital at least twice for this complication. The most predominant tumors were colon (31%), gastric (26%) and ovary (21%) malignancies. All patients suffered from abdominal symptoms at admission. Mean hemoglobin and albumin values at first admission were, respectively: 3.18 g/dL and 10.84 g/dL; average values at readmission were 2.89 g/dL and 10.65 g/dL (statistically significant). Treatments prescribed were: corticoids (95.92%), prokinetic drugs (80.61%), opioids (77.55%), other analgesic drugs (69.39%), and hyoscine butylbromide (16.32%). Several analgesic drugs were often prescribed at the same time. Time between tumor diagnosis and death was 14 months (P 25-75 : 5.2-25.3). Time between first episode of malignant bowel obstruction and death was 33 days (P 25-75 : 0-67); 67% of patients die during their first admission to hospital because of this condition; 69% of patients die at a palliative care unit. Conclusions: abdominal tumors are the main cause of malignant bowel obstruction. All patients with this entity suffer from abdominal symptoms at admission. Readmissions are frequent. Patients with lower hemoglobin and albumin levels probably die sooner. Dexamethasone was the most commonly prescribed treatment; hyoscine butylbromide was least commonly prescribed. Patients with malignant bowel obstruction due to peritoneal carcinomatosis have decreased survival. These patients die frequently during their first admission and in the hospital setting.