What initial management steps should I take for a patient presenting with suspected bowel obstruction?

Initial management steps for a patient presenting with suspected bowel obstruction include:

• Perform a thorough clinical assessment to identify signs and symptoms suggestive of bowel obstruction such as colicky abdominal pain, absolute constipation (no passage of flatus or stool), vomiting, abdominal distension, and tenderness.
• Exclude other causes of constipation and obstruction by clinical examination including abdominal and rectal examination, unless contraindicated (e.g., chemotherapy patients).
• Arrange urgent hospital admission for specialist assessment and management, especially if there are signs of complications such as peritonitis, sepsis, or suspected perforation.
• Initiate supportive care with intravenous fluid resuscitation to correct dehydration and electrolyte imbalances.
• Provide analgesia and antiemetics as needed to manage symptoms.
• Withhold oral intake (nil by mouth) to prevent further bowel distension and aspiration risk.
• Consider nasogastric tube insertion for gastric decompression if vomiting or significant distension is present.
• Request urgent imaging, preferably abdominal X-ray or CT scan, to confirm diagnosis, identify the level and cause of obstruction, and detect complications such as perforation or ischemia.
• Consult surgical teams early for assessment and planning of definitive management, which may include surgery or stenting depending on cause and patient suitability.

These steps are based on clinical features of bowel obstruction and the need to exclude complications and initiate timely specialist care to reduce morbidity and mortality ²,⁴,⁵.