40 yrs female with prior appendectomy and C-sections present with acute abdominal pain, distention and emesis for 2 days .No passage of stools or gas .Overall stable vital signs but focally tender in the lower abdomen. She is now on bowel rest, intravenous fluids -Nasogastric tube suctioning. Abdominal radiograph below. WHAT WOULD YOU DO?
A-Gastrografin oral challenge
B- Colonoscopy /EGD
C-Laparoscopy & proceed as indicated
D- Laparotomy & proceed as indicated
E- CT-SCAN Abdomen & Pelvis