SHM Converge Scientific Abstract ePoster Gallery-A Venting Intervention: How to Approach a Trammeled Digestive Tract in the Setting of Advanced Abdominal Malignancy

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This case report describes a 66-year-old woman with metastatic plasmacytoid bladder cancer and peritoneal carcinomatosis who developed severe, persistent nausea and bilious vomiting during a prolonged hospitalization. Although she was initially admitted for aspiration pneumonia, her gastrointestinal symptoms worsened despite repeated imaging that showed no mechanical obstruction.<br /><br />The case highlights malignant gastroparesis, an underrecognized complication of advanced abdominal malignancy. Possible causes include direct tumor invasion of the enteric nervous system or a paraneoplastic process. Because this condition is a diagnosis of exclusion, other common causes in cancer patients had to be ruled out, including small bowel obstruction, gastric outlet obstruction, medication side effects, ileus, and narcotic bowel syndrome. In this patient, lack of response to bowel rest, aggressive bowel regimens, and prokinetic therapy supported malignant gastroparesis.<br /><br />Several symptom-directed treatments were tried, including antiemetics, haloperidol, erythromycin, octreotide, dexamethasone, and metoclopramide. However, durable relief was not achieved until a multimodal palliative approach was used. Placement of a venting gastrostomy tube, along with a PleurX catheter and PICC line for a PCA pain pump, significantly improved symptom control and allowed discharge home with hospice support.<br /><br />The report emphasizes that for patients with advanced cancer, treatment should focus not only on life-prolonging therapy but also on relieving distressing symptoms and aligning interventions with patient goals. Regular goals-of-care discussions were essential in determining a plan that prioritized returning home and maximizing time with family.

Asset Subtitle

Kira E. Champelli

Meta Tag

Author List Kira E. Champelli, Michael J. Hendricks

Category Clinical Vignettes

Concept Malignant Gastroparesis

Concept Intractable Nausea

Concept Vomiting

Concept Venting Gastrostomy

Concept Goals of Care

Distinguished Non-Finalist

Presenter Organization Oregon Health & Science University

Presenting Author Kira E. Champelli

Track Adult

Keywords

malignant gastroparesis

metastatic bladder cancer

peritoneal carcinomatosis

persistent nausea

bilious vomiting

diagnosis of exclusion

palliative care

venting gastrostomy tube

hospice support

goals of care

Malignant Gastroparesis

Intractable Nausea

Vomiting

Venting Gastrostomy

Goals of Care