You are asked to see a 72 year old man who is 5 days post elective left hemicolectomy for cancer. His co-morbidities include COPD, ischaemic heart disease and rheumatoid arthritis.

On assessment he is drowsy but responsive to voice.  He is poorly perfused, HR =120, BP = 100/60. His heart sounds and lung fields are normal; his abdomen is diffusely tender and distended.  He has intravenous access, and has been commenced on fluids and O2 .

Please outline your most likely diagnosis and a differential diagnosis for this patient’s deterioration.

Disclaimer: the viva stem above is the original CICM stem, acquired from their publicly available past papers. However, because the college do not make the rest of the viva text or marking criteria available, the rest has been confabulated. It sounds like a plausible viva and it can be used for the purpose of practice, but all should be aware that it does not represent the "true" canonical CICM viva station.