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 small bowel obstruction before referral to secondary care include:

Assessment: Conduct a thorough clinical assessment to identify signs of intestinal obstruction such as colicky abdominal pain, absolute constipation (no passage of flatus or stool), vomiting, and abdominal distension.
Supportive care: Initiate supportive measures including nil by mouth (to rest the bowel), intravenous fluid resuscitation to correct dehydration and electrolyte imbalances, and insertion of a nasogastric tube if vomiting or significant distension is present to decompress the stomach.
Monitoring: Monitor vital signs and urine output closely to detect any signs of deterioration or complications such as sepsis or bowel ischemia.
Urgent referral: Refer the patient promptly to secondary care for further assessment and management, especially if there are signs of complicated obstruction or systemic compromise.

These steps aim to stabilise the patient and prevent complications while arranging definitive care in hospital.

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