76 years old female presented with abdominal pain x 4 days

76 years old female presented with

abdominal pain x 4 days

abdominal distension x 4 days

DRE … empty rectum

Potassium = 2.77 mmol/l

What’s your opinion and further plan?

Thanks all for your suggestion and valuable concepts.

I did laparotomy this patient and the operative finding was mobilised , no attachment of caecum with peritoneum with volvulous. Distension of caecum and very thinning of the wall (+) with impending perforation