A 42-year-old woman is brought to the emergency department complaining of sudden-onset, severe, colicky abdominal pain that has become constant over the past 6 hours. She has also experienced multiple episodes of bilious vomiting and has not passed flatus or stool since the pain began. Her medical history is unremarkable, and she has never undergone abdominal surgery. She is an avid long-distance runner. Her temperature is 38.6°C (101.5°F), pulse is 122/min, respirations are 22/min, and blood pressure is 92/58 mm Hg. Physical examination reveals an asymmetrically distended abdomen with a tympanitic mass palpable in the mid-abdomen. There is marked right-sided tenderness with involuntary guarding and rebound tenderness. Laboratory studies show a leukocyte count of and a serum lactate of . An upright plain abdominal radiograph demonstrates a large, comma-shaped dilated bowel loop projecting from the right lower quadrant toward the left upper quadrant, with a paucity of gas in the distal colon. Which of the following is the most appropriate next step in management?
- Immediate exploratory laparotomyAnswer
- BEndoscopic detorsion via colonoscopy
- CNasogastric tube decompression and serial abdominal examinations
- DComputed tomography of the abdomen and pelvis with intravenous contrast
- EIntravenous administration of neostigmine