Optimal management strategies for patients presenting with complicated peritoneal carcinomatosis in the emergency setting: a clinical perspective

Peritoneal carcinomatosis (PC) often represents an advanced intra-abdominal malignancy. In some cases, bowel obstruction represents the first manifestation of cancer; in others, it indicates disease progression in previously treated patients. Individuals presenting to the emergency department with symptoms such as vomiting and abdominal pain require prompt assessment to determine the appropriateness of conservative versus surgical management, decisions frequently made under prognostic uncertainty and limited survival expectations. Recent evidence suggests that surgery can offer symptomatic relief in selected patients, though it is associated with significant perioperative risks and has a limited impact on long-term survival. Non-operative management – including bowel rest, somatostatin analogues, corticosteroids, and antiemetics – remains the first-line approach in hemodynamically stable patients. Given the absence of formal guidelines, this commentary underscores the need for evidence-based recommendations, expert consensus, and the integration of palliative principles into emergency care. Communication strategies, individualized triage, and ethical alignment with patient values are essential to avoid inadvertently harmful interventions. Data from the ongoing World Society of Emergency Surgery (WSES)-endorsed international “End-of-Life Care” survey are expected to inform future best practices.