Soru

A 51-year-old woman is brought to the emergency department complaining of sudden-onset, severe, and unremitting abdominal pain for the past 6 hours. She has vomited bilious material twice since the pain began. Her surgical history is notable for a total abdominal hysterectomy performed five years ago for uterine fibroids. On presentation, her temperature is 38.3°C (100.9°F), heart rate is 118/min, and blood pressure is 105/65 mm Hg. Physical examination shows a significantly distended abdomen with focal rigidity and pronounced rebound tenderness in the left lower quadrant. Bowel sounds are absent. Laboratory results reveal a leukocyte count of 16,500/mm³ and a serum lactate level of 3.2 mmol/L. A CT scan of the abdomen and pelvis with intravenous contrast demonstrates a transition point in the distal jejunum, poor enhancement of the bowel wall distal to the transition point, a mesenteric "whirl" sign, and moderate free pelvic fluid. Which of the following is the most appropriate next step in management?