Pain management in patients with irreversible intestinal failure poses unique challenges, requiring a multidisciplinary strategy that addresses complex pharmacological needs, systemic complications, and prognostic uncertainty. This report describes a patient with gastrointestinal hypoganglionosis whose pain was refractory to conventional opioids due to intestinal malabsorption and dysmotility. Subcutaneous ketamine was successfully employed as an alternative analgesic. Optimal care relied on close interdisciplinary collaboration; however, discrepancies between the patient’s hope for curative treatment and the life-limiting nature of her condition delayed advance care planning and smooth transitions to community-based support.
The rarity of the condition and associated prognostic uncertainty underscore the importance of early integration of palliative care for patients with non-malignant intestinal failure. Tailored care models that effectively link hospital and community services are crucial to align treatment goals with patient and family priorities and to prevent fragmented care during critical transitions.
