A patient with suspected small bowel obstruction but stable hemodynamics should be managed with which initial steps?

A patient with suspected small bowel obstruction but stable hemodynamics should be managed with which initial steps?

• A. NPO, IV fluids, and nasogastric decompression
• B. Immediate exploratory laparotomy
• C. Oral hydration and ambulation
• D. CT scan first

Answer: (B)

When a patient has suspected small bowel obstruction but remains hemodynamically stable, the first approach is nonoperative management focused on resuscitation and decompression rather than rushing to surgery. The goal is to correct fluid and electrolyte losses, prevent dehydration, and relieve the blockage while monitoring for signs of deterioration. Start with nothing by mouth to keep the bowel quiet and reduce aspiration risk. Give isotonic intravenous fluids to restore circulating volume and correct electrolyte disturbances. Place a nasogastric tube to decompress the stomach, which helps decrease vomiting, distension, and risk of aspiration, and supports comfort and gradual resolution of the obstruction. Concurrently, assess vital signs, urine output, and electrolytes, and provide pain control as appropriate. Imaging, such as a CT scan with contrast or abdominal radiographs, should be obtained to confirm the diagnosis and evaluate for complications like strangulation or a closed-loop obstruction, but this should not delay resuscitation and decompression. Surgical intervention becomes necessary if there are peritoneal signs, hemodynamic instability, evidence of bowel ischemia or perforation, or if nonoperative management fails after a period of observation.

When a patient has suspected small bowel obstruction but remains hemodynamically stable, the first approach is nonoperative management focused on resuscitation and decompression rather than rushing to surgery. The goal is to correct fluid and electrolyte losses, prevent dehydration, and relieve the blockage while monitoring for signs of deterioration.

Start with nothing by mouth to keep the bowel quiet and reduce aspiration risk. Give isotonic intravenous fluids to restore circulating volume and correct electrolyte disturbances. Place a nasogastric tube to decompress the stomach, which helps decrease vomiting, distension, and risk of aspiration, and supports comfort and gradual resolution of the obstruction. Concurrently, assess vital signs, urine output, and electrolytes, and provide pain control as appropriate.

Imaging, such as a CT scan with contrast or abdominal radiographs, should be obtained to confirm the diagnosis and evaluate for complications like strangulation or a closed-loop obstruction, but this should not delay resuscitation and decompression. Surgical intervention becomes necessary if there are peritoneal signs, hemodynamic instability, evidence of bowel ischemia or perforation, or if nonoperative management fails after a period of observation.