Soru

An emergency medical response team brings a $58$-year-old female patient to the acute care bay for evaluation of progressively worsening abdominal pain and obstipation lasting $48$ hours. She states that her pain was initially crampy, intermittent, and manageable, but it abruptly transitioned into a severe, constant, and diffuse ache approximately $4$ hours prior to arrival. She has had multiple episodes of bilious emesis today. Her medical history is significant for stage IIB cervical cancer, which was managed with a radical hysterectomy and adjuvant pelvic chemoradiation $15$ years ago. Vital signs include a temperature of $38.7^\circ\text{C}$ ($101.7^\circ\text{F}$), a pulse of $124\text{ /min}$, a blood pressure of $92/60\text{ mmHg}$, and a respiratory rate of $24\text{ /min}$. On physical examination, the patient lies completely rigid on the stretcher and refuses to change positions. Her abdomen is markedly distended and tympanic. There is exquisite, diffuse tenderness to light palpation across all quadrants, accompanied by prominent involuntary guarding and rebound tenderness. Bowel sounds are absent. Laboratory evaluation reveals a leukocyte count of $18,500/\text{mm}^3$ and a serum lactate concentration of $4.8\text{ mmol/L}$. An upright chest radiograph is negative for subdiaphragmatic free air. A supine abdominal radiograph demonstrates multiple dilated small bowel loops with prominent air-fluid levels and a complete absence of distal colonic gas. Which of the following is the most appropriate next step in management?