A woman with malignant bowel obstruction who did not want to die with tubes

A 74-year-old woman came, in July, 1994, to a general surgical ward with a 5-month history of lumbar pain and intermittent constipation. A computed tomogram (CT) scan suggested extensive carcinoma of the tail of the pancreas. She underwent a laparotomy, at which the tumour was found to involve the tail of the pancreas, spleen, left kidney, and a cuff of stomach. The tumour was resected; histology confirmed an infiltrating pancreatic adenocarcinoma. She remained well for 5 months before developing back pain and vomiting. A repeat CT scan showed tumour recurrence involving stomach and small bowel with associated obstruction, lymphadenopathy, and hepatic metastases. She underwent a second laparotomy, at which a palliative gastroenterostomy was fashioned. Unfortunately, her vomiting continued.