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Three days after undergoing an open cholecystectomy, a 73-year-old man has fever and abdominal pain. He has hypertension, type 2 diabetes mellitus, chronic obstructive pulmonary disease, and benign prostatic hyperplasia. He had smoked one pack of cigarettes daily for 40 years but quit 1 year ago. He does not drink alcohol. Prior to admission to the hospital, his medications included lisinopril, metformin, ipratropium, and tamsulosin. He appears acutely ill and lethargic. His temperature is 39.5°C (103.1°F), pulse is 108/min, respirations are 18/min, and blood pressure is 110/84 mm Hg. He is oriented only to person. Examination shows a 10-cm subcostal incision that appears dry and non-erythematous. Scattered expiratory wheezing is heard throughout both lung fields. His abdomen is distended with tenderness to palpation over the lower quadrants. Laboratory studies show:Hemoglobin 10.1 g/dlLeukocyte count 19,000/mm3Serum Glucose 180 mg/dlUrea Nitrogen 25 mg/dlCreatinine 1.2 g/dlLactic acid 2.5 mEq/L (N = 0.5 - 2.2 mEq/L)Urine Protein 1+RBC 1-2/hpfWBC 32-38/hpfWhich of the following is the most likely underlying mechanism of this patient's current condition?

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