Soru

Paramedics bring an 83-year-old female resident of an assisted living facility to the emergency department. She has experienced severe, colicky abdominal pain accompanied by nausea and intractable vomiting for the past four days. Staff note that her emesis, which initially contained partially digested food, has become dark brown and malodorous over the last 12 hours. She has not passed flatus or stool for two days. Her medical history includes hypertension, type 2 diabetes mellitus, and severe osteoarthritis. Her temperature is 37.8°C (100.0°F), blood pressure is 108/65 mm Hg, pulse is 112/min, and respirations are 18/min. Physical examination reveals a distended and tympanitic abdomen. Bowel sounds are high-pitched and hyperactive in rushes. There is diffuse mild tenderness to palpation, but no rebound guarding or rigidity. Groin examination reveals no palpable masses. Laboratory results show a leukocyte count of 13,500/mm³ and serum creatinine of 1.7 mg/dL. A noncontrast CT scan of the abdomen and pelvis demonstrates dilated loops of small bowel with a transition point in the distal ileum. There is a 3.5-cm radiopaque, lamellated structure intraluminally at the transition point, and branching radiolucencies are seen within the central liver. Which of the following is the most appropriate next step in management?