A middle aged patient presents with acute onset persistent severe epigastric abdominal pain. The pain radiates to the back and is relieved by sitting up or bending forward. It is accompanied by nausea, vomiting, and dyspnea. Exam shows diffuse tenderness, abdominal distension, and hypoactive bowel sounds. He is admitted to the hospital for supportive management.
Unfortunately, overnight, he develops fever, tachypnea, tachycardia, and hypotension. He is transferred to the critical care unit and started on norepinephrine and vasopressin for septic shock after adequate fluid resuscitation. A CT is shown below:
He has acute kidney injury and acute respiratory distress syndrome requiring intubation, but over the next few weeks, he is stabilized and eventually extubated. Four weeks after the initial presentation, he still has chronic low grade fever, nausea, lethargy, and inability to eat.
He then undergoes surgery even though the mortality rate is somewhere between 4-25% and complications include intra-abdominal fluid collections, bleeding, fistulas, incisional hernias, poor glucose control, and need for enzyme therapies.
Challenge: What was the operation?
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