A patient is a 51-year-old woman with history of travel to India for an elective abdominal liposuction. The procedure was complicated by hollow viscus perforation with subsequent development of septic shock and abdominal sepsis. The patient is transferred to your hospital after 10 days abroad for a higher level of care.
On admission, the patient is hemodynamically unstable, requiring vasopressors, has a temperature of 38.7°C, has diffuse bilateral crackles and rales, and the abdomen is rigid with guarding. A CT of the chest and abdomen shows changes compatible with ARDS and multiple large rim-enhancing collections through the abdomen. Her white blood cell count is 27,000/mm3, and her hemoglobin in 7.0 g/dL. Blood gases show a pH of 7.2 and an elevated lactate. Interventional radiology has placed a pigtail catheter in the largest collection, and the procedure report mentions a large volume of purulent fluid that was drained successfully. Fluid and blood cultures are pending.