Andrea Škripeková, Lucia Dzurillová, Katarína Jakubovitšová
Malignant bowel obstruction occurs when there is reduced or absent progress of the forward flow of gastric and intestinal contents through the gastrointestinal tract (GIT) in the state of malignant disease. There are dilemmas in the patients with advanced cancer at the decision making process: not/performing surgery, initiating the home parenteral nutrition (HPN) program and termination of HPN at the end of life. Assessing metabolic reserves, technical possibilities of surgery and communicating it with the patients are the keys factors at the decision making. Pharmacologic management encompasses antisecretory, antiemetic and analgesic drugs, which must be given in parenteral route. Controversions remains in the indication and the termination of HPN. By maintaining of anabolic reserves, the patients could have profit from HPN. Possible harm of HPN at the end of life is the reason for termination of HPN at the end of life, and the challenge is to communicate it with the patient.