<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 68-year-old man is brought to the emergency department for increasing colicky lower abdominal pain and distention for 4 days. He has nausea. He has not passed flatus for the past 2 days. His last bowel movement was 4 days ago. He has hypertension, type 2 diabetes mellitus, and left hemiplegia due to a cerebral infarction that occurred 2 years ago. His current medications include aspirin, atorvastatin, hydrochlorothiazide, enalapril, and insulin. His temperature is 37.3C 99.1F, pulse is 90min, and blood pressure is 12684 mm Hg. Examination shows a distended and tympanitic abdomen. There is mild tenderness to palpation over the lower abdomen. Bowel sounds are decreased. Digital rectal examination shows an empty rectum. Muscle strength is decreased in the left upper and lower extremities. Deep tendon reflexes are 3 on the left and 2 on the right. The remainder of the examination shows no abnormalities. Laboratory studies are within normal limits. An x-ray of the abdomen in left lateral decubitus position is shown. The patient is kept nil per os and a nasogastric tube is inserted. Intravenous fluids are administered. Which of the following is the most appropriate next step in the management of this patient?? A: Metoclopramide therapy, B: Endoscopic detorsion, C: Intravenous antibiotic therapy, D: Colonoscopy, E: Rectal tube insertion,  <response>: This is a clinical vignette describing a 68-year-old man with increasing abdominal pain, distention, nausea, and constipation. The history and physical exam findings are consistent with bowel obstruction. The x-ray shows dilated loops of large bowel with air-fluid levels, confirming the diagnosis. The management steps should aim to relieve the obstruction. Metoclopramide may help gastric emptying but does not address the obstruction. Antibiotics are not yet indicated. Colonoscopy is risky in the setting of complete obstruction and would not relieve the obstruction. Rectal tube insertion can help decompress the colon but does not treat the cause. Endoscopic detorsion is the most appropriate next step, as it can relieve the point of obstruction in a minimally invasive way compared to surgery.B: Endoscopic detorsion 