Four Days After Undergoing a Total Abdominal Hysterectomy for Atypical

Four days after undergoing a total abdominal hysterectomy for atypical endometrial hyperplasia, a 59-year-old woman reports abdominal bloating and discomfort. She has also had nausea without vomiting. She has no appetite despite not having eaten since the surgery and drinking only sips of water. Her postoperative pain has been well controlled on a hydromorphone patient-controlled analgesia (PC A) pump. Her indwelling urinary catheter was removed on the second postoperative day and she is now voiding freely. Although she lays supine in bed for most of the day, she is able to walk around the hospital room with the help of a physical therapist. Her temperature is 36.5°C (97.7°F) , pulse is 84/min, respirations are 10/min, and blood pressure is 132/92 mm Hg. She is 175 cm (5 ft 9 in) tall and weighs 115 kg (253 lb) ; BMI is 38 kg/m2. Examination shows a mildly distended, tympanic abdomen; bowel sounds are absent. Laboratory studies are within normal limits. An x-ray of the abdomen shows uniform distribution of gas in the small bowel, colon, and rectum without air-fluid levels. Which of the following is the most appropriate next step in the management of this patient?

A) Gastrografin enema
B) Esophagogastroduodenoscopy
C) Reduce use of opioid therapy
D) Colonoscopy
E) Return to operating room for bowel resection
F) Begin total parenteral nutrition
G) Slowly advance diet