Soru

A $71$-year-old woman is assessed by the rapid response team five days after undergoing an elective sigmoid resection with primary anastomosis for recurrent complicated diverticulitis. The nursing staff activated the response due to acute mental status changes and hypotension. Her temperature is $39.4^\circ\text{C}$ ($102.9^\circ\text{F}$), blood pressure is $78/48\text{ mm Hg}$, pulse is $132/\text{min}$, and respirations are $26/\text{min}$. Pulse oximetry shows $93\%$ on room air. The patient is lethargic and oriented only to person. Abdominal examination reveals a rigid, board-like abdominal wall with severe diffuse tenderness and absent bowel sounds. A closed-suction pelvic drain, which had been outputting minimal clear fluid, has abruptly filled with $200\text{ mL}$ of dark, foul-smelling, turbid liquid. Electrocardiography demonstrates sinus tachycardia alongside $2\text{-mm}$ ST-segment depressions in leads II, III, and aVF. Laboratory studies reveal a leukocyte count of $22,000/\text{mm}^3$, a serum lactate level of $5.4\text{ mmol/L}$, and a serum troponin I concentration of $0.8\text{ ng/mL}$ (normal: $<0.04\text{ ng/mL}$). Intravenous crystalloid resuscitation is initiated. Which of the following is the most appropriate next step in the management of this patient?