Abstract / Summary
Introduction Malignant bowel obstruction secondary to peritoneal carcinomatosis (PC) is a challenging end-stage complication in which operative palliation must balance symptom relief against perioperative burden and limited survival. This study evaluated palliative stoma creation not only as an outcome-based intervention, but as a practical decision-making strategy integrating patient selection, hospitalization burden, and individualized operative planning in anatomically hostile abdomens. Methods We retrospectively reviewed 46 patients with PC who developed mechanical intestinal obstruction refractory to conservative management between 2016 and 2025 at a tertiary academic referral center. Demographic characteristics, tumor origin, peritoneal carcinomatosis index (PCI), operative strategy, stoma type, incision location, postoperative outcomes, complications, and survival were analyzed. Hospitalization burden was descriptively assessed as the proportion of median remaining survival spent during the index admission. Results The study included 24 (52.2%) female and 22 (47.8%) male patients with a mean age of 61.5 ± 14.4 years (range 29-91). The mean PCI score was 14.9 ± 4.3; 67.4% of the cases underwent loop ileostomy; and the mean operative time was 95 minutes. Mean time to oral intake was 2.7 days, and median length of hospitalization was 11 days. The overall complication rate was 23.9%, and 30-day mortality was 13.0%. Median survival was 60 days, making the index hospitalization approximately 18.3% of median remaining survival. No significant correlation was observed between PC index and duration of hospitalization (r = 0.071, P = .658) or survival (r = ‒0.242, P = .128), although these negative findings should be interpreted cautiously given the limited sample size. Conclusion Palliative stoma creation provides rapid symptom relief in selected patients with PC and mechanical intestinal obstruction. Its value should be judged less by survival extension than by whether the procedure can restore oral intake, allow discharge, and preserve meaningful time outside the hospital. Individualized surgical planning may facilitate safe palliation when standard stoma construction is limited by hostile abdominal conditions.