Soru

An 82-year-old woman is evaluated in the emergency department for a 4-day history of progressively worsening, colicky abdominal pain accompanied by nausea and feculent vomiting. Her medical history includes hypertension, osteoarthritis, and moderate dementia. She lives with her daughter, who is her legally appointed healthcare proxy. Her estranged son recently arrived at the hospital and has been demanding to direct her medical care.

Vitals:
Temperature: $37.6^\circ\text{C}$ ($99.7^\circ\text{F}$)
Heart rate: $105/\text{min}$
Blood pressure: $110/70 \text{ mm Hg}$

Physical examination reveals a distended and tympanitic abdomen with high-pitched bowel sounds. There is mild, diffuse tenderness to palpation but no guarding, rigidity, or rebound tenderness.

Laboratory studies:
Leukocytes: $11,500/\text{mm}^3$
Lactate: $1.6 \text{ mmol/L}$
Liver function tests: Within normal limits

A computed tomography scan of the abdomen and pelvis without contrast reveals dilated loops of small bowel up to the terminal ileum, air in the biliary tree, and a $3.5\text{-cm}$ radiopaque, calcified mass impacted in the distal ileum. The colon is decompressed.

The son demands that the medical team transition her to comfort care, stating, 'She is too frail for any surgery, and I am the oldest child, so I make the decisions.' The daughter states, 'She has excellent quality of life at home. I want whatever is medically necessary to relieve this blockage.'

Which of the following is the most appropriate next step in management?