A -year-old woman is brought to the emergency department from a skilled nursing facility due to severe abdominal pain and altered mental status. Staff report that she has had progressive abdominal distention, nausea, and no bowel movements for the past days. Her past medical history is significant for Parkinson disease, chronic constipation, and moderate Alzheimer dementia. Her temperature is (), pulse is , blood pressure is , and respirations are . Physical examination reveals a massively distended abdomen that is diffusely tender to palpation, with severe rigidity and involuntary guarding. Bowel sounds are absent. Laboratory studies show a leukocyte count of and a serum lactate level of . An upright abdominal radiograph demonstrates a markedly dilated loop of colon extending from the pelvis to the right upper quadrant in an inverted U-shape, lacking haustra. Which of the following is the most appropriate next step in management?
- Emergent exploratory laparotomyCevap
- BFlexible sigmoidoscopy
- CComputed tomography of the abdomen and pelvis
- DAdmission to the intensive care unit for serial abdominal examinations
- ETransition to comfort-focused care and transfer back to the facility