A 45-Year-Old Woman Is Evaluated on Postoperative Day 3 Due

A 45-year-old woman is evaluated on postoperative day 3 due to nausea and vomiting.  The patient underwent a total abdominal hysterectomy for symptomatic uterine fibroids, and the surgery was complicated by ureter injury and stent placement.  She was placed on a clear liquid diet on postoperative day 2, when she began to have some nausea.  Since then, the patient has had multiple episodes of vomiting but no hematemesis.  She has not passed flatus or had a bowel movement since the surgery.  Temperature is 37.2 C (99 F) , blood pressure is 130/80 mm Hg, and pulse is 80/min.  The abdomen is mildly distended and has decreased bowel sounds.  The incision is tender to palpation but has no surrounding erythema or discharge.  Laboratory results are as follows: Abdominal x-ray is shown in the exhibit.  In addition to intravenous fluid administration, which of the following is the best next step in the management of this patient?

A) Bowel rest and serial examinations
B) Broad-spectrum antibiotics
C) Rectal enema
D) Small bowel follow-through
E) Urgent surgical exploration

Correct Answer:

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