Paramedics bring a -year-old woman to the emergency department due to acute, unremitting abdominal pain and persistent bilious vomiting that began hours ago. Her medical history is notable for a total abdominal hysterectomy for uterine fibroids performed weeks ago. She reports that the pain initially started as intermittent cramps but rapidly progressed to become constant and excruciating over the last hours. Her temperature is (), blood pressure is , pulse is , and respirations are . The patient appears diaphoretic, toxic, and lies completely still on the gurney. Physical examination reveals a markedly distended abdomen with involuntary guarding, board-like rigidity, and severe rebound tenderness in all four quadrants. Auscultation yields absent bowel sounds. Laboratory analysis demonstrates a leukocyte count of and a serum lactate level of . An upright abdominal radiograph displays multiple dilated loops of small intestine with prominent air-fluid levels and an absence of colonic gas. Which of the following is the most appropriate next step in the management of this patient?
- Immediate exploratory laparotomyAnswer
- BNasogastric tube insertion, intravenous hydration, and serial abdominal examinations
- CComputed tomography scan of the abdomen and pelvis with intravenous contrast
- DUrinalysis, chest radiography, and peripheral blood cultures to determine the fever etiology
- EArterial blood gas analysis to calculate the expected respiratory compensation for metabolic acidosis