Soru

A 34-year-old woman is evaluated in the emergency department for sudden-onset, severe, and cramping mid-abdominal pain that began 8 hours ago. The pain is continuous but worsens in waves. She has had three episodes of vomiting, which recently became bilious. Her past medical history is significant for a laparoscopic Roux-en-Y gastric bypass performed 2 years ago for class III obesity, resulting in a 45-kg (99-lb) weight loss. Her temperature is 37.8°C (100.0°F), pulse is 115/min, blood pressure is 108/68 mm Hg, and respirations are 18/min. Physical examination reveals an anxious patient in obvious distress. The abdomen is mildly distended with focal tenderness in the mid-abdomen, but there is no rebound tenderness or rigidity. Bowel sounds are high-pitched.

Laboratory results:
Leukocyte count: 14,500/mm³
Hemoglobin: 13.2 g/dL
Serum sodium: 138 mEq/L
Serum potassium: 3.6 mEq/L
Blood urea nitrogen: 24 mg/dL
Serum creatinine: 1.1 mg/dL
Serum lactate: 3.2 mmol/L (Normal: 0.5 - 2.2 mmol/L)

A computed tomography (CT) scan of the abdomen and pelvis with intravenous contrast reveals dilated loops of small bowel with a transition point. The mesenteric vessels appear rotated around a central axis, and there is mild adjacent mesenteric edema. There is no free intraperitoneal air.

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