What initial management steps should be taken for a patient with suspe

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Initial management steps for a patient with suspected large bowel obstruction before referral to secondary care include:

Recognise symptoms and signs of obstruction: These include colicky abdominal pain, absolute constipation (no passage of flatus or stool), vomiting, and abdominal distension, which may indicate intestinal obstruction requiring urgent assessment .
Assess for complications: Look for signs of peritonitis, sepsis, or perforation such as abdominal rigidity, guarding, altered mental state, or systemic signs of infection, which necessitate immediate hospital referral .
Provide supportive care: Initial management in primary care should focus on stabilising the patient, including ensuring adequate hydration and pain control with simple analgesia like paracetamol, avoiding NSAIDs and opioids due to risk of perforation .
Do not delay referral: Patients with suspected large bowel obstruction should be referred urgently to secondary care for further assessment and management, as definitive treatment options such as stenting or emergency surgery may be required .
Investigations and diagnostics: While primary care may not perform imaging, secondary care will typically perform blood tests and imaging (e.g., contrast CT) to confirm diagnosis and plan treatment ,.

What initial management steps should be taken for a patient with suspected large bowel obstruction before referral to secondary care?