When should I consider referring a patient with bowel obstruction to secondary care?

Consider referring a patient with suspected bowel obstruction to secondary care urgently if they present with signs of systemic illness such as fever, tachycardia, or hypotension, or if they are systemically unwell. This is particularly important if there is suspicion of complications like ischaemia or perforation.

Also refer urgently if there is diagnostic uncertainty after primary care assessment, or if there are features suggestive of malignancy such as an abdominal or rectal mass, unexplained weight loss, or iron-deficiency anaemia. In such cases, a suspected cancer pathway referral should be considered to ensure diagnosis or exclusion of colorectal cancer within 2 weeks.

Emergency referral is warranted if there are signs of acute abdomen or complications such as cauda equina syndrome or acute neurological deficits.

In summary, urgent or emergency referral to secondary care is indicated for suspected bowel obstruction when the patient is systemically unwell, has signs of complications, or when cancer is suspected based on clinical features or positive investigations.

These recommendations align with NICE and CKS guidance on referral for colorectal cancer and acute gastrointestinal conditions.

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