bowel obstruction and tender abdomen

[HopefulForever]

My mother recently had an NG tube put in, in order to drain fluid due to a bowel obstruction.  It was surprising because less fluid than expected was drained.  Before the tube was placed her abdomen was tighter, now she has had the tube for about almost 3 days and her abdomen is softer.  Her count has also come down 300 points after chemo was started, although 300 points does not mean much compared to what her count is but every little thing helps (at least that's what i believe).  I am wondering is a softer abdomen a good sign or is it a bad sign?  The chemo seems to help and there is another treatment i would like to try but my mothers oncologist believes there is nothing more and does not want to continue treatment for her.  Is this procedure or normal?

[Annekathryn Goodman, M.D.]

ok -electricity back on:

second reason for a bowel obstruction:
Small bowel obstruction.  If there is one area of obstruction and the rest of the bowel is working well, the area of blockage will prevent food and intestinal fluid from passing through. The bowel before the blockage will dilate and become swollen. This will hurt and the abdomen will become distended. The area of the bowel after the blockage will be collapsed.  When a NG tube is placed, alot of fluid will be released and the distention will improve. This type of obstruction can be surgically corrected.

On the other hand, if there are multiple areas of obstruction, the bowel cannot dilate except between the two blocked segments. But placing a NG tube maybe not release alot of fluid.  It is less likely to be able to surgical correct this.  In this setting it is no safe to give chemo- there is a risk of severe peritonitis from the leaking of bowel contents. If the blood counts are low from chemotherapy, there is a risk of death.

The third form of obstruction is obstruction of the large intestine. It is possible to make this diagnosis by CT scan or barium (or gastrograffin - which is water soluble) enema.  The appropriate intervention for this is an emergency colostomy.  An NG tube will not bring up alot of fluid.

Please let us know what happens
best wishes

[Annekathryn Goodman, M.D.]

:

Your mother must have an obstruction of the intestine.  There are three major areas of the intestine that can get obstructed in the setting oHi There,

I am so sorry to hear about your mother's condition. You should ask her oncologist for more information about why he/she does not want to give more chemotherapy. But here is what might be going onf recurrent ovarian cancer. It is also possible to have more than one area of obstruction going on at the same time.

Gastric outlet obstruction: When the cancer coats and surrounds the outside of the stomach, the stomach cannot stretch and fill normally with fluid and food.  The cavity of the stomach becomes tiny and everytime  a person tries to eat, they vomit.  Putting a nasogastric tube into the stomach will relieve some of the build up of gastric  fluid.  However, not much fluid will come out.  It is not possible to surgically fix a gastric outlet obstruction. chemotherpay will not help much either. Usually this is a reason to change from active therapy to palliative care
to be continued (I am writing this from Bangladesh and the electricity just went out)