A 78-year-old man from a residential aged care facility, with long-standing constipation, presents with three days of increasing abdominal distension and no passage of stool or flatus for 48 hours. He has vomited once. His temperature is 36.8°C, pulse 88/min and blood pressure 130/80 mmHg. The abdomen is grossly distended and tympanitic but soft, with no rebound or guarding. Abdominal X-ray shows a single markedly dilated loop of large bowel without haustral markings, arising from the pelvis and extending towards the right upper quadrant. Which one of the following is the most appropriate next step in management?
Keep going — a set of ten like this one, one at a time.
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