8/12/2019 SBO Journal of Palliative Medicine

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Clearing Bowel Obstruction and Decreasing Pain

in a Terminally Ill Patient via Manual Physical Therapy

ecreasing pain and improving unction and quality oe are important topics or patients that reuse, or are notndidates or traditional medical interventions, and thoseend stages o disease. Patients with inoperable, metastatic

owel carcinoma that experience pain and small bowelbstruction (SBO) as a result o adhesions are a subset oese patients. Te standard treatment, adhesion and/orsection surgery ollowed by post-surgical medications toevent inection and decrease pain, may not be ideal in

d-stage cancer patients. We treated such a patient using aanual sof tissue physical therapy with goals o decreasingr pain and alleviating symptoms o bowel obstructioncondary to adhesions successully, using a protocol weveloped initially to open allopian tubes that were blocked

y adhesions.

Te patient was a 61-year-old married woman with astory o multiple abdominopelvic surgeries over the last years including hysterectomy, ileostomy and ileostomyversal with chemotherapy and radiation or treatment o

age IIIB ovarian/peritoneal carcinoma. She experiencedBO episodes every 2-3 months and had five adhesiolysisnd/or resection surgeries to attempt to repair theowel. Because she had undergone a recent exploratoryparoscopy that revealed metastasis to the omentum, herhysicians were reluctant to perorm any urther surgeries,nd the patient requested no more surgical interventions.

he was unable to eat or drink, so a peripherally insertedntral catheter (PICC line) was placed, and she receivedtal parenteral nutrition (PN) daily. She experienced

ronic pain associated with the SBOs at a level o 4-5/10at increased throughout the day with movement. Te

atient was undergoing chemotherapy, and medicated withexium 40mg qd, Compazine 10mg prn, Zoran 4mg prn,tivan 1mg qd, multivitamin bid, Vitamin D 2000mg qd,o-Enzyme Q10 qd and Dilaudid prn or pain. Her goalsere to relieve the abdominal pain, decrease SBO incidents,t a normal diet and travel.

Te patient underwent 29 hours o a manual sof tissuehysical therapy 16 over six months, ocused on detaching

e abdominal adhesions and was instructed in sel

treatment techniques. At initial evaluation, she said shmust reside near a hospital, due to PICC line and recurSBOs.

She demonstrated improvement through the durationo therapy with significant pain decrease and unctionaincrease. By discharge, her physician had removed thePICC lines because she had returned to eating a norma(including hamburger). She was then able to travel over

with her husband, a significant increase in her quality o

Alleviating pain and dysunction, and returning liequality are challenging goals in patients with inoperablgastrointestinal cancer. Here we report a successulnonsurgical treatment or abdominal adhesions, pain adysunction in a terminally ill patient. Beore therapy,she lived with recurring SBOs, repeat surgeries, pain andysunction. Her only nutrition was intravenous PN.Afer undergoing this manual sof tissue physical therashe was able to eat a normal diet, and participate in

activities she desired.

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Amanda D. Rice, PhD, Evette DAvy Reed, PT, Kimberly Patterson, PTA, LMT,

Belinda F. Wurn, PT, and Lawrence J. Wurn, LMT

urnal of Palliative Medicine

lume 16, Number 3, 2013

Mary Ann Liebert, Inc.

OI: 10.1089/jpm.2012.0458

This is a copy of an article published in the Journal of Palliative Medicine 2013 copyright Ma

Liebert, Inc.; Journal of Palliative Medicine is available online at: http://online.liebertpu