A 52-year-old woman presents to the emergency department with a 24-hour history of severe, sudden-onset abdominal pain, intractable nausea, and an inability to pass flatus or stool. Her past medical history is significant for systemic lupus erythematosus, for which she takes hydroxychloroquine and low-dose prednisone. She has never undergone abdominal surgery. Vital signs show a temperature of 37.4°C (99.3°F), blood pressure of 118/76 mmHg, and a heart rate of 105/min. Physical examination reveals a markedly asymmetric, distended abdomen with diffuse tympany to percussion. There is moderate tenderness to palpation in the mid-abdomen without rigidity or rebound. Laboratory results, including a complete blood count and basic metabolic panel, are within normal limits. An upright abdominal plain radiograph demonstrates a massively dilated, ectopic large bowel loop originating in the right lower quadrant and projecting toward the left upper quadrant, displaying a 'kidney bean' appearance. A single large air-fluid level is visualized, and there is a paucity of gas in the distal colon. Which of the following is the most appropriate next step in management?
- Urgent exploratory laparotomyAnswer
- BEndoscopic decompression via flexible sigmoidoscopy
- CIntravenous administration of neostigmine
- DNasogastric tube insertion and serial abdominal examinations
- EComputed tomography of the abdomen with oral contrast