COMPARISON BETWEEN EFFECTIVENESS OF NON-NASOGASTRIC INTUBATION AND NASOGASTRIC INTUBATION IN PATIENTS WITH SMALL INTESTINAL OBSTRUCTION: A RANDOMIZED CONTROLLED TRIAL

Background: Small intestinal obstruction (SIO) remains one of the most common surgical emergencies encountered in clinical practice, particularly in developing countries. Conservative management has been the standard approach for uncomplicated cases, with nasogastric (NG) decompression traditionally being a central component. However, the necessity and superiority of NG decompression in improving patient outcomes remains debated. Objective: To compare the effectiveness of conservative management of small intestinal obstruction with and without the use of nasogastric intubation and to evaluate whether NG decompression should remain a standard component of non-operative care. Methods: This randomized controlled trial was conducted over six months at Sandeman Provincial Hospital, Quetta, Pakistan. One hundred patients aged between 18 to 60 years with radiologically confirmed SIO were randomized into two groups: Group A received standard conservative management along with NG intubation, while Group B received standard management without NG decompression. Effectiveness was measured based on clinical resolution of two or more symptoms: abdominal distension, absolute constipation, and absent gut sounds. Hospital stays, symptom resolution rate, and complication incidence were analyzed. Data were analyzed using SPSS version 22 with p<0.05 considered statistically significant. Results: The average age was 41.3±11.1 years, and 58% were male. Group A (NG group) showed significantly shorter hospital stays (3.84±1.57 days) compared to Group B (4.64±1.52 days) (p=0.011). Treatment effectiveness was higher in the NG group (82%) compared to the non-NG group (40%) (p<0.001). Subgroup analysis showed consistent superiority of NG decompression across age, gender, and clinical characteristics. Minor complications were more common in the NG group but did not outweigh the benefits. Conclusion: Nasogastric decompression significantly enhances conservative treatment outcomes in patients with SIO. Despite minor discomfort, its effectiveness in symptom resolution and reduction in hospital stay supports its routine use in non-operative settings.