Approach to periumbilical and lower abdominal pain Quiz: Ace Your Exams

A 75-year-old man develops sudden-onset crampy abdominal pain and bloody diarrhea on day 7 of his hospital admission for acute myocardial infarction. The pain initially began in the left lower abdomen but has now become diffuse. Past medical history is significant for hypertension, and a 35-pack-year smoking history. Temperature is 37.7°C (99.9°F), blood pressure is 94/62 mmHg, pulse is 130/min, respiratory rate is 22/min, and oxygen saturation is 94% on room air. On physical examination, the patient appears pale and diaphoretic. Abdominal examination reveals a rigid distended abdomen with diffuse abdominal tenderness, and guarding. Laboratory findings include a white blood cell count of 18,000/mm³ and a lactate level of 4.5 mmol/L. Intravenous fluids and broad-spectrum antibiotics are initiated. Upright chest radiograph shows no evidence of pneumoperitoneum. Which of the following is the most appropriate next step in management?