{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T13:06:27Z","timestamp":1793451987501,"version":"4.5.0"},"reference-count":32,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T00:00:00Z","timestamp":1783900800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Trop Doct"],"abstract":"<jats:p>Malignant bowel obstruction (MBO) is a known, devastating complication of advanced intra-abdominal malignancy. International management guidelines are derived from high-income settings and rely on resources: computed tomography, self-expanding metal stents, total parenteral nutrition, specialist palliative care, that are inconsistently available in low- and middle-income countries (LMICs). Clinicians in LMICs therefore manage MBO within a fundamentally different diagnostic and therapeutic landscape, usually without context-specific guidance. Surgery dominates management but carries high morbidity and mortality, particularly in patients with ECOG performance status \u22653, serum albumin &lt;30\u202fg\/L, ascites and peritoneal carcinomatosis. Emerging LMIC-based data confirm these patterns: a prospective Kenyan series reported 30-day postoperative mortality of 10.8% for malignant obstruction, while a South African review of 510 obstructed colorectal cancer patients found stomas were used twice as frequently as stents, the reverse of high-income country practice. No prognostic tool has been validated in LMIC populations. MBO care in LMICs demands a recalibration of international evidence to local realities. Our proposed context-adapted decision framework offers a structured, evidence-informed approach to rational surgical decision-making that can be applied immediately, even in settings lacking advanced imaging or endoscopic services.<\/jats:p>","DOI":"10.1177\/00494755261467832","type":"journal-article","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T10:48:52Z","timestamp":1783939732000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Management of malignant bowel obstruction in sub-Saharan Africa: A structured narrative review of evidence, contextual challenges and clinical practice gaps"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-3298-8987","authenticated-orcid":false,"given":"Odulusi","family":"Daniel","sequence":"first","affiliation":[{"name":"Kabale University School of Medicine (KABSOM), Kabale Regional Referral Hospital (KRRH)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2451-3324","authenticated-orcid":false,"given":"Gamukama","family":"Tuhaise","sequence":"additional","affiliation":[{"name":"Head of Department of Surgery, Kabale Regional Referral Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4105-1840","authenticated-orcid":false,"given":"Izimba","family":"Daniel","sequence":"additional","affiliation":[{"name":"Kabale University School of Medicine (KABSOM)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tumwesige","family":"Charles","sequence":"additional","affiliation":[{"name":"Kabale Regional Referral Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3528-598X","authenticated-orcid":false,"given":"Nek Arthur","family":"Jonathan","sequence":"additional","affiliation":[{"name":"Kabale Regional Referral Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4487-7344","authenticated-orcid":false,"given":"Mugarura","family":"Robert","sequence":"additional","affiliation":[{"name":"Head of Department, department of Surgery-KABSOM, Kabale University School of Medicine (KABSOM)"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,13]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.29297"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1002\/jso.26930"},{"key":"e_1_3_2_4_2","article-title":"Management of inoperable malignant bowel obstruction using the 4-step BOUNCED diet","volume":"38","author":"Allan L","year":"2024","unstructured":"Allan L, Hatchett N, Skene SS, et al. 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