Pain management in a patient with intestinal failure in the palliative care setting: case report

Abstract

Background: Managing pain in patients with incurable intestinal failure requires a multidisciplinary approach that addresses complex pharmacological and systemic challenges while navigating prognostic uncertainties. Case presentation: This case report of gastrointestinal hypoganglionosis demonstrates the use of subcutaneous ketamine when conventional opioids fail due to intestinal malabsorption and dysmotility. Effective care required interdisciplinary collaboration, yet persistent discordance between the patient’s curative expectations and her life-limiting prognosis hindered timely advance care planning and community support transitions. Conclusions: Prognostic uncertainty, compounded by the condition’s rarity, highlights the need for early palliative care integration in non-malignant conditions, to ensure that care goals align with patient and family priorities. The case report advocates for adaptable care models that bridge inpatient and community services, even amid prognostic ambiguity, to prevent fragmented care during critical transitions.