These operations were called "peak and shriek" where I trained. The surgeon would open the abdomen, and then "shriek" because he'd find so much dead bowel that the patient couldn't survive. He'd then close, because there was nothing he could do.https://twitter.com/MarkHoofnagle/status/1095571502009856000 …
Yes, it's horrible. The decision isn't hard if 100% of the bowel is dead (not survivable) but becomes very hard when, say, 50% or 75% is dead. Very low chance of survival in elderly patients, but not zero, and needing total parenteral nutrition for the rest of life is not benign.