A 77-year-old man is admitted to the ICU from the operation theater. He was presented to the emergency department with abdominal pain earlier that day. His medical history included treated hypertension and hypercholesterolemia, previous heavy alcohol intake, and mild cognitive impairment. In the emergency department, he was drowsy and confused when roused and was peripherally cold with cyanosis. The systemic arterial blood pressure was 75/50 mm Hg, and the heart rate was 125 beats per minute.
The abdomen was tense and distended. After the administration of one liter of intravenous crystalloid to restore the blood pressure, a CT scan of the abdomen showed extraluminal gas and suspected extraluminal feces consistent with a perforated sigmoid colon. He was treated with intravenous antibiotics and taken to the operating room for laparotomy. During this procedure, gross fecal peritonitis…
