A -year-old woman presents to the emergency department with a -hour history of sudden-onset, severe, colicky periumbilical pain that radiates to her back. She also reports several episodes of severe nausea and nonbilious emesis. Her medical history is notable for morbid obesity treated with a laparoscopic Roux-en-Y gastric bypass years ago. Her temperature is (), blood pressure is , pulse is , and respirations are . On physical examination, her abdomen is soft and non-distended but exquisitely tender to deep palpation in the mid-abdomen. There is no rebound tenderness or muscle guarding. Bowel sounds are hyperactive. Laboratory studies show a leukocyte count of and a serum lactate level of (normal: ). A computed tomography scan of the abdomen and pelvis with intravenous contrast reveals a cluster of dilated small bowel loops in the left upper quadrant and a swirling pattern of the mesenteric vessels at the root of the mesentery. Which of the following is the most appropriate next step in management?
- Immediate surgical explorationAnswer
- BNasogastric tube decompression and intravenous fluid hydration
- CAdministration of water-soluble oral contrast
- DIntravenous broad-spectrum antibiotics and serial abdominal examinations
- EUpper gastrointestinal endoscopy