Soru

An $84$-year-old woman is brought to the emergency department from her assisted living facility due to a $3$-day history of progressively worsening nausea, bilious vomiting, and colicky abdominal pain. She has not had a bowel movement or passed flatus for $36$ hours. Her medical history is significant for severe osteoporosis and dementia. Over the past year, she has unintentionally lost $10\text{ kg}$ ($22\text{ lb}$). Vital signs show a temperature of $38.2^\circ\text{C}$ ($100.8^\circ\text{F}$), blood pressure of $96/60\text{ mmHg}$, and pulse of $115/\text{min}$. On physical examination, the abdomen is distended, tympanic, and exhibits high-pitched, tinkling bowel sounds. There is diffuse abdominal tenderness but no overt rigidity. Passive extension and internal rotation of the right hip elicits sharp pain radiating down the medial aspect of the right thigh. Laboratory studies reveal a leukocyte count of $15,200/\text{mm}^3$ and a serum lactate of $3.4\text{ mmol/L}$. Computed tomography of the abdomen and pelvis with intravenous contrast demonstrates markedly dilated loops of small bowel with a transition point in the right pelvis. At the transition point, a small segment of bowel passes through the obturator foramen; this segment shows absent mucosal enhancement. Which of the following is the most appropriate next step in management?