Malignant bowel obstruction in patients affected by advanced cancer: clinical and radiologic findings to support decision-making

Malignant bowel obstruction in patients affected by advanced cancer: clinical and radiologic findings to support decision-making process in the emergency department
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Vol. 22 No. 1 (2026)
Malignant bowel obstruction in patients affected by advanced cancer: clinical and radiologic findings to support decision-making process in the emergency department
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22 December 2025
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18 February 2026
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Malignant bowel obstruction
End of Life care
gastrointestinal cancer
gynecological cancer
Emergency Department
Authors
Alberto Manno
alberto.manno@policlinicogemelli.it
Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy.
Elena Rodolfino
Department of Diagnostic Imaging and Oncologic Radiotheraphy Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.
Benedetta Gui
Department of Diagnostic Imaging and Oncologic Radiotheraphy Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.
Roberto Iezzi
Department of Diagnostic Imaging and Oncologic Radiotheraphy Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma; Faculty of Medicine and Surgery, Università Cattolica del Sacro Cuore, Roma, Italy.
Viola De Luca
Department of Diagnostic Imaging and Oncologic Radiotheraphy Fondazione Policlinico Universitario A. Gemelli IRCCS, Italy.
Camilla Panico
Department of Diagnostic Imaging and Oncologic Radiotheraphy Fondazione Policlinico Universitario A. Gemelli IRCCS, Italy.
Andrea Benicchi
Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy.
Michele Cosimo Santoro
Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy.
Francesco Franceschi
Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma; Faculty of Medicine and Surgery, Università Cattolica del Sacro Cuore, Roma, Italy.
Marcello Candelli
Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma; Faculty of Medicine and Surgery, Università Cattolica del Sacro Cuore, Roma, Italy.
Malignant Bowel Obstruction (MBO) is an often preterminal complication of gastrointestinal and gynecological cancers. We tried to identify clinical and radiological parameters suggesting early providing of End of Life (EOL) care protocols in this kind of patients at Emergency Department (ED) presentation. We retrospectively analyzed 60 ED patients admitted for MBO in a one-year period, identifying a Bad Prognosis Group (BPG) (died or transferred to EOL care centers) and a Good Prognosis Group (GPG) (prosecution of treatment with curative intent). Predictors of bad prognosis were: time of onset of symptoms, Eastern Cooperative Oncology Group performance status (ECOG), Charlson Comorbidity Index (CCI), past intestinal obstruction, previous abdominal surgery and therapeutic strategy adopted. Computed tomography scan studies were reviewed by expert radiologists. CCI ≥ 4 (p=0,030), ECOG score ≥ 2 (p=0,016), no large bowel occlusion (p=0,045), mesenteric infiltration retraction (p=0,047) and extraperitoneal metastases (p=0,049) confirmed independent predictive value of bad prognosis at multivariate analysis. Identifying clinical and radiological criteria at ED evaluation can be useful to better identification of those MBO patients who may benefit from early providing EOL care protocols.
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CRediT authorship contribution
All authors contributed equally to the present article.
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Malignant bowel obstruction in patients affected by advanced cancer: clinical and radiologic findings to support decision-making process in the emergency department. (2026).
Emergency Care Journal
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