Question 112 · LEK · Mechanical obstruction

A 68-year-old woman came in the evening to the ER because of colic abdominal pain, fecal vomiting, intermittent diarrhea and constipation for 7 days, and the presence of fresh blood in the stool. She reports she had lost 12 kg for the last 3 months without any specific diet. On physical examination the abdomen is distended, without muscle guarding, with audible resonant peristaltic sounds. On per rectum examination - the rectal ampulla is empty. Indicate the correct management:

1. AA. admission to the internal medicine ward for the hospital observation.
2. BB. abdominal ultrasound imaging and the observation in the out-patient settings.
3. CC. urgent out-patient colonoscopy.
4. DD. admission to the general surgery ward and qualification to the surgical treatment of the ileus.
5. EE. discharging the patient to home and referral for the control visit in the surgery out-patient clinic on the next day.