A 55-year-old woman arrives at the emergency department reporting a two-day history of progressively worsening, crampy periumbilical pain accompanied by bilious vomiting. She reports an inability to pass flatus or stool for the past 18 hours. Her past medical history is notable for a total abdominal hysterectomy performed eight years ago. Current vital signs are temperature (), blood pressure , heart rate , and respiratory rate . Physical examination reveals a significantly distended abdomen with high-pitched bowel sounds. There is marked focal tenderness with voluntary guarding and rebound localized to the left lower quadrant. Laboratory evaluation shows a leukocyte count of and a serum lactate level of . Upright abdominal plain films demonstrate multiple dilated small intestinal loops with prominent air-fluid levels and a paucity of colonic gas. Which of the following is the most appropriate next step in the management of this patient?
- Immediate exploratory laparotomyAnswer
- BIntravenous fluid resuscitation and serial abdominal examinations
- CCross-sectional imaging of the abdomen and pelvis with oral contrast
- DEndoscopic decompression with a water-soluble contrast enema
- EIntravenous administration of broad-spectrum antimicrobial agents as monotherapy