Palliation of gastrointestinal obstruction.

Mrs E.B. is a 54-year-old woman with a 1-year history of ovarian cancer. She was diagnosed with abdominopelvic recurrence 6 months ago, complicated by a rectovaginal fistula and bouts of bowel obstruction. She suffered from fatigue and anorexia, and also had perineal pain due to excoriation from the fecal incontinence via the fistula. Mrs E.B. was admitted to the palliative care unit of a small community hospital where these problems were addressed successfully with a combination of medications in addition to her baseline octreotide. She fared quite well for about a month, then developed vomiting. Over a period of 2 days, vomiting episodes became more frequent, occurring mostly after meals.