An 84-year-old man who resides in a nursing care facility is transferred to the hospital due to progressively worsening abdominal swelling and failure to pass any gas or stool over the past three days. His medical history includes Parkinson disease, type 2 diabetes mellitus, and chronic constipation requiring daily laxatives. The patient complains of crampy abdominal discomfort but denies nausea, vomiting, or chills. On arrival, his temperature is C ( F), blood pressure is mmHg, pulse is /min, and respiratory rate is /min. Physical examination demonstrates a markedly distended, tympanic abdomen. The abdomen is diffusely and mildly tender to palpation, but there is no rigidity, guarding, or rebound tenderness. Digital rectal examination reveals an empty rectal vault. Laboratory studies show a leukocyte count of and a serum lactate level of mmol/L. An upright abdominal radiograph displays a massive, dilated loop of large bowel arising from the pelvis and projecting toward the right upper quadrant, characterized by an absence of haustral markings and a central double-wall thickness. Which of the following is the most appropriate next step in management?
- Flexible sigmoidoscopyAnswer
- BUrgent exploratory laparotomy
- CComputed tomography of the abdomen and pelvis with intravenous contrast
- DIntravenous neostigmine
- EPlacement of a nasogastric tube and serial abdominal examinations