Gastric outlet or high bowel obstruction in palliative care

High bowel obstruction occurs at the level of the gastric outlet, the duodenum or the small bowel. The clinical picture is usually of sudden onset of vomiting, often with little or no nausea, occurring very soon after eating or drinking. The vomitus frequently contains undigested food. Upper abdominal bloating and early satiety are present. A similar clinical picture occurs with gastroparesis.

Fluid and electrolyte loss may be more significant in high bowel than in low bowel obstruction. This is exacerbated by loss of fluid through vomiting caused by high obstruction, or from drainage from a jejunostomy or high ileostomy. If luminal contents higher in the bowel can reach the lower bowel, more electrolytes and other nutrients will be absorbed than can occur when there is high bowel obstruction.

Patients with high bowel obstruction generally have a very poor prognosis, and are not usually considered for parenteral nutrition support. Physically active patients with an obstructed oesophagus may initially benefit from subcutaneous fluids.