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Inoperable MBO Palliation — SCE Medical Oncology MCQ

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HardSupportive & Palliative OncologyInoperable MBO PalliationSCE Medical Oncology

A patient with peritoneal carcinomatosis has radiologically complete multilevel bowel obstruction, continuous vomiting and colicky pain. Surgery is not suitable. Which proposed syringe-pump drug should be avoided because its prokinetic action can worsen colic in complete obstruction?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Metoclopramide 30–60 mg over 24 hours

Explanation lettering: E = shown as A · C = shown as B · B = shown as C · A = shown as E

A is correct. Metoclopramide can be useful in partial obstruction without colic, but its prokinetic action may aggravate painful contractions against a complete mechanical block and should be avoided here. Hyoscine butylbromide reduces colic and secretions within the cited dose range. A short dexamethasone trial may reduce oedema and occasionally improve obstruction. Octreotide is a second-line antisecretory option under specialist advice. Haloperidol is a non-prokinetic antiemetic option. Route, compatibility and final dose require individual review; the key discriminator is complete obstruction with colic, not the mere presence of malignant bowel obstruction.

Reference: Scottish Palliative Care Guidelines: bowel obstruction: https://www.rightdecisions.scot.nhs.uk/scottish-palliative-care-guidelines/symptom-management/bowel-obstruction/