Colonic volvulus Quiz: Ace Your Exams

A 73-year-old man presents to the emergency department with crampy diffuse abdominal pain, constipation, and bloating that has been going on for three days. Today, the patient started vomiting. He reports a four-year history of constipation that has typically responded to miralax. He has no other significant past medical history. Temperature is 37°C (98.7°F), pulse is 90/min, and blood pressure is 123/85 mmHg. Laboratory studies reveal leukocytosis and an elevated lactate level. Hyperactive bowel sounds are heard on auscultation of the abdomen. The abdomen is distended and tympanitic with diffuse tenderness and guarding without rebound tenderness. Digital rectal exam is unremarkable. A plain radiograph of the abdomen is below, showing a coffee bean sign. In addition to supportive care, which is the most appropriate management for this patient?  

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