Year 4middle twist
A 68-year-old man presents to the emergency department with a 24-hour history of worsening abdominal pain, nausea, and vomiting. He has a history of open sigmoid colectomy for diverticulitis 10 years ago. On examination, his abdomen is distended and diffusely tender, with no palpable masses or hernias. He is afebrile, but his heart rate is 110 bpm despite a 2-liter bolus of IV fluids. Blood tests show a white cell count of 15 ×10⁹/L and lactate of 3.5 mmol/L. A CT abdomen and pelvis with contrast shows dilated loops of small bowel with a transition point in the mid-abdomen, no free air, and possible pneumatosis intestinalis (Gas in intestine walls).
What is the most appropriate next step in management?