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Palliative Management of Perforated Viscus — SCE Palliative Medicine MCQ

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HardPain ManagementPalliative Management of Perforated ViscusSCE Palliative Medicine

A 55‑year‑old man with advanced gastric cancer develops severe abdominal pain. CT reveals a perforated viscus with free intraperitoneal air. He is on the palliative care register with a Palliative Performance Scale of 30%. Surgery is deemed too high‑risk. What is the most appropriate palliative management approach?

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Correct answer: A — Aggressive symptom management with IV/SC opioids for pain

Option A is correct. It aligns with UK palliative practice: avoid futile high‑risk surgery in an unfit patient with PPS 30% and instead focus on relieving suffering. The high morbidity and mortality of emergency abdominal surgery in advanced cancer counsel against operative intervention in this context ([pubmed.ncbi.nlm.nih.gov](https://pubmed.ncbi.nlm.nih.gov/26307872/?utm_source=openai)). NHS England palliative guidelines support medical management of obstruction/perforation symptoms when surgery is inappropriate ([england.nhs.uk](https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/48/2020/01/Palliative-Care-Pain-and-Symptom-Control-Guidelines.pdf?utm_source=openai)). Option C under‑treats pain. Option E subjects patient to likely futile harm. Option B represents disproportionate escalation. Option D neglects duty to relieve suffering.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/cancer/palliative-care