A 65-year-old male presents to the ED with nausea, vomiting, and severe abdominal pain. Past history is significant for prior sigmoid colectomy for diverticulitis 10 years ago. On physical exam, his temperature is 100.9 ° F, blood pressure is 110/ 80 mmHg, and heart rate is 110/ min. His abdomen has a well-healed midline scar and is distended. Bowel sounds are hyperactive with occasional rushes and tinkles. He has marked right upper quadrant tenderness to palpation with guarding. The rest of the abdominal exam is unremarkable. Abdominal series demonstrates one loop of markedly distended small bowel in the right upper quadrant with an air fluid level. No gas is seen in the colon or
rectum. Laboratory values demonstrate a WBC count of 18 × 103/ μL (normal 4.1- 10.9 × 103/ μL) with 15 % bands and a serum lactate of 5 mmol/ L (normal 0.5- 1.6 mmol/ L), BUN 30 mg/ dL (7- 21 mg/ dL), and creatinine 1.2 mg/ dL (0.5- 1.4 mg/ dL). Amylase, lipase, and liver chemistries are normal. NG tube and IV fluids are given. What is the next step in the management?
(A) Exploratory laparotomy
(B) Admit for close observation
(C) Upper GI with small bowel follow through with barium
(D) Upper GI with small bowel follow through with Gastrografin
(E) Right upper quadrant ultrasound