In patients at high risk of a full blown<unk>  who have no abdominal pain but increasing distension, nausea, vomiting and reducing bowel movements:
Metoclopramide 30mg via CSCI over 24 hours
Sodium docusate 200mg twice daily (or an alternative stool softener)
+/- Dexamethasone 8mg daily SC
In many patients surgery or stenting is unlikely to be helpful, although for very proximal unifocal lesions or for patients otherwise very fit and healthy it may be worth considering
Usually<unk>  is indicative that a patient is coming into the last few weeks or month of life. A kind but frank discussion about this is usually helpful.
If vomiting and abdominal pain are very severe, consider drainage NG tube. If severe vomiting and discomfort are not major issues then it may be best to avoid an NG tube, especially if a more comfort-based approach to treatment is being considered
Treat vomiting and distension with anti-secretorary agents:
Ranitidine 150mg via CSCI over 24 hours
Octreotide 600mg via CSCI over 24 hours
Treat nausea with an anti-emetic, e.g.
Haloperidol 2.5mg via CSCI over 24 hours
+ Haloperidol 1mg SC 2-hourly PRN for nausea
Treat abdominal pain with an anti-spasmodic + an opioid, e.g.
Hyoscine butylbromide 60mg via CSCI over 24 hours
A low dose opioid via CSCI over 24 hours and SC PRN
Also consider dexamethasone 8mg daily SC
If intractable vomiting persists, consider a venting PEG.
In patients where comfort and quality of life are the key concerns, IV fluids may not be helpful unless thirst is an issue.
In patients where life-prolongation is very important, IV hydration and TPN in hospital or in the home setting may be appropriate.
Ranitidine 150mg via CSCI over 24 hours
Octreotide 600mg via CSCI over 24 hours
Haloperidol 2.5mg via CSCI over 24 hours
+ Haloperidol 1mg SC 2-hourly PRN for nausea
Hyoscine butylbromide 60mg via CSCI over 24 hours
A low dose opioid via CSCI over 24 hours and SC PRN
Malignant bowel obstruction
Behavioral-related
Large bowel obstruction
Lack of exercise
Small bowel obstruction
Diet-related
Intestinal ischemia
Fecal impaction