An 82-year-old male presented to the emergency with complaints of abdominal distention, nausea and vomiting since the past 3 days. It was also associated with pain in the abdomen which was diffuse in nature, non-radiating with no aggravating or relieving factors. Patient gives history of decreased passage of stool and flatus since the past 2 days. Patient gives history of smoking since the past 30 years. Patient had past medical history of coronary artery disease (post-angioplasty), CKD (Chronic Kidney Disease), Hypertension and COPD (Chronic Obstructive Pulmonary Disease). Patient had a history of old Pulmonary TB for which he had undergone treatment. On admission, patient was conscious, oriented, in a state of shock with BP-80/60 mmHg on noradrenaline support of 5 ml/hr, Pulse rate-120 beats per minute (ECG was done which showed Atrial Fibrillation with fast ventricular rate), afebrile. Chest-bilateral air entry was present with occasional ronchi, CVS-S1S2 present, P/Adistended with guarding, diffuse tenderness and absent bowel sounds. 2D Echo showed global hypokinesia with ejection fraction-50%. Initial resuscitation was done, and patient was optimized. Due to unstable condition of the patient and lack of improvement after initial supportive therapy patient was planned for emergency laparotomy.