{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T15:00:48Z","timestamp":1778943648080,"version":"3.51.4"},"reference-count":14,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2023,7,11]]},"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:p>Presented is a case of a man in his 20s with gastric cancer with metastasis to a perineal nodule and the splenic flexure (previously resected due to acute bowel obstruction) who presented with prolonged, intermittent, inoperable bowel obstruction likely due to adhesions, exacerbated by functional ileus due to substantial opioid requirement. In an episode of obstruction during the described admission, the patient remained obstructed after more than 10 days of medical management. The patient suffered from intense abdominal distention and pain, necessitating hundreds of oral morphine equivalents daily. A ropivacaine thoracic epidural infusion was initiated, allowing decreased opioid use and relief of opioid-induced ileus contributing to his bowel obstruction. He subsequently had multiple formed bowel movements, which quickly decreased the patient\u2019s abdominal distention and immediate risk of perforation. This case explores epidurals as an underutilised approach to pain management in metastatic gastric malignancy and inoperable malignant bowel obstructions.<\/jats:p>","DOI":"10.1136\/bcr-2022-253665","type":"journal-article","created":{"date-parts":[[2023,7,24]],"date-time":"2023-07-24T12:35:13Z","timestamp":1690202113000},"page":"e253665","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Epidural pain management in advanced gastric cancer with inoperable malignant bowel obstruction"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9045-3529","authenticated-orcid":false,"given":"Riley","family":"Bohan","sequence":"first","affiliation":[{"name":"Internal Medicine, University of Florida College of Medicine, Gainesville, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7044-9979","authenticated-orcid":false,"given":"Jeffery","family":"Budweg","sequence":"additional","affiliation":[{"name":"Internal Medicine, University of Florida College of Medicine, Gainesville, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen","family":"Vose","sequence":"additional","affiliation":[{"name":"Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mircea","family":"Sorin","sequence":"additional","affiliation":[{"name":"Internal Medicine, University of Florida College of Medicine, Gainesville, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,7,24]]},"reference":[{"key":"2025082801473556000_16.7.e253665.1","doi-asserted-by":"crossref","first-page":"159","DOI":"10.2147\/CMAR.S29297","article-title":"Malignant bowel obstruction in advanced cancer patients: epidemiology, management, and factors influencing spontaneous resolution","volume":"4","author":"Tuca","year":"2012","journal-title":"Cancer Manag Res"},{"key":"2025082801473556000_16.7.e253665.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2008.02.028"},{"key":"2025082801473556000_16.7.e253665.3","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1177\/107327480000700205","article-title":"Interventional treatment of cancer pain: the fourth step in the world health organization analgesic ladder","volume":"7","author":"Miguel","year":"2000","journal-title":"Cancer Control"},{"key":"2025082801473556000_16.7.e253665.4","doi-asserted-by":"publisher","DOI":"10.1007\/s11912-009-0042-2"},{"key":"2025082801473556000_16.7.e253665.5","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1002\/jso.25451","article-title":"Malignant bowel obstruction","volume":"120","author":"Krouse","year":"2019","journal-title":"J Surg Oncol"},{"key":"2025082801473556000_16.7.e253665.6","doi-asserted-by":"crossref","first-page":"367","DOI":"10.12788\/jhm.3187","article-title":"Pharmacologic management of malignant bowel obstruction: when surgery is not an option","volume":"14","author":"Hsu","year":"2019","journal-title":"J Hosp Med"},{"key":"2025082801473556000_16.7.e253665.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2015.12.340"},{"key":"2025082801473556000_16.7.e253665.8","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1016\/j.jpainsymman.2013.01.004","article-title":"Regional anesthesia approaches to pain management in pediatric palliative care: a review of current knowledge","volume":"46","author":"Rork","year":"2013","journal-title":"Journal of Pain and Symptom Management"},{"key":"2025082801473556000_16.7.e253665.9","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/S1359-6349(05)80273-3","article-title":"The Amangement of obstructive GI cancer: a modern approach","volume":"3","author":"Audisio","year":"2005","journal-title":"European Journal of Cancer Supplements"},{"key":"2025082801473556000_16.7.e253665.10","first-page":"299","article-title":"Palliative management of intestinal obstruction in patients with advanced gynaecological cancer","volume":"7","author":"Bais","year":"2002","journal-title":"CME Journal of Gynecologic Oncology"},{"key":"2025082801473556000_16.7.e253665.11","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3959(91)90110-J"},{"key":"2025082801473556000_16.7.e253665.12","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0142(19981101)83:9<2015::AID-CNCR19>3.0.CO;2-R"},{"key":"2025082801473556000_16.7.e253665.13","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.2009.170"},{"key":"2025082801473556000_16.7.e253665.14","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1097\/SLA.0000000000002566","article-title":"Adherence to enhanced recovery protocols in NSQIP and association with Colectomy outcomes","volume":"269","author":"Berian","year":"2019","journal-title":"Ann Surg"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2022-253665","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T08:47:43Z","timestamp":1756370863000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2022-253665"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7]]},"references-count":14,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2023,7,24]]},"published-print":{"date-parts":[[2023,7]]}},"alternative-id":["10.1136\/bcr-2022-253665"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2022-253665","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7]]}}}