The first step in treating a patient with an intestinal obstruction and no comorbidities is which?

• A. Nasogastric decompression
• B. Invasive hemodynamic monitoring
• C. Abdominal exploration
• D. Administration of antibiotics

Answer: (A)

Decompressing the bowel with a nasogastric tube is the best first step because, in an uncomplicated intestinal obstruction, the priority is to stabilize the patient and relieve distension while correcting dehydration and electrolyte imbalances. An NGT lowers intraluminal pressure, reduces vomiting and the risk of aspiration, and buys time to reassess and treat conservatively. Invasive hemodynamic monitoring is reserved for unstable patients, while abdominal exploration is reserved for signs of strangulation, perforation, or failure of nonoperative management. Antibiotics aren’t routinely started unless infection or perforation is suspected.