Optimising Non-operative Management of Inoperable Malignant Bowel Obstruction: A Clinical Review for Surgical Practice.

Inoperable malignant bowel obstruction (MBO) is a frequent and distressing complication of advanced intra-abdominal malignancy, particularly colorectal and ovarian cancer, and is associated with substantial morbidity and limited survival. Management is primarily palliative, with emphasis on symptom control rather than disease modification. For the practising surgeon, MBO represents a common clinical scenario requiring structured non-operative decision-making. This structured narrative review synthesises current evidence on non-operative management strategies for inoperable MBO, based on a systematic literature search. Interventions evaluated include pharmacological therapies, combination regimens, and selected adjunctive measures. Somatostatin analogues, particularly octreotide, demonstrate the most consistent benefit in reducing gastrointestinal secretions and vomiting. Corticosteroids and antiemetics provide adjunctive symptom control, while combination regimens appear to offer enhanced efficacy compared with monotherapy, although supporting evidence remains limited. The available literature is heterogeneous, with relatively few high-quality randomised studies and limited standardisation of outcome measures. Consequently, clinical practice is largely guided by symptom-driven, individualised approaches. Future research should prioritise well-designed multicentre trials, standardised treatment protocols, and incorporation of patient-reported outcomes to strengthen the evidence base and inform clinical practice.