Authors: Isaia Maddalena , Alessandro Viganò , Tanja Fusi-Schmidhauser

Abstract

Background: Octreotide is used as an antisecretory treatment in inoperable malignant bowel obstruction, but evidence in non-malignant postoperative small-bowel obstruction is scarce.

Case Presentation: A 62-year-old woman underwent emergency descending-colon resection, abdominal lavage, and double-barrel colostomy for perforation with purulent four-quadrant peritonitis. Serial computed tomography demonstrated progressive small-bowel obstruction without signs of ischemia or perforation. Given severe malnutrition, sarcopenia, comorbidities, and frailty, reoperation was considered disproportionately burdensome. Continuous intravenous octreotide at 0.9 mg/24 h was added to nasogastric decompression, bowel rest, parenteral nutrition, and symptom-directed medication. Nausea and colicky pain improved within approximately 12 hours, and abdominal distension decreased subsequently. Liquid stool appeared through the colostomy after four days. Parenteral nutrition was discontinued and octreotide reduced to 0.6 mg/24 h, then stopped the following day, together with nasogastric tube removal. Oral intake gradually resumed, and she was discharged home after 17 days in the palliative care unit.

Conclusion: Octreotide initiation was temporally associated with rapid symptom relief and was followed by de-escalation of supportive measures. This case supports considering octreotide as a symptom-directed measure, rather than attributing mechanical resolution to the drug alone.

Keywords: Octreotide, small-bowel obstruction, postoperative complications, palliative care, case report.