Intra-abdominal sepsis

Intra-abdominal sepsis is frequently seen and dealt with by surgeons. It presents as a spectrum of conditions ranging from uncomplicated localized infection through to severe systemic sepsis with generalized peritoneal infection. Complicated sepsis is frequently associated with a systemic inflammatory response, which can rapidly progress into septic shock and multi-organ failure. Despite advances in intensive care medicine and surgical techniques this remains a condition with a high mortality and morbidity. The principles in the management of complicated intra-abdominal sepsis include rapid diagnosis using appropriate imaging techniques, the administration of broad-spectrum antibiotics within the ‘golden hour’ of diagnosis and goal-directed fluid resuscitation. Source control is paramount and may use either surgical or radiological techniques. Surgical source control may take the form of straightforward procedures such as appendicectomy or cholecystectomy or in severe sepsis other techniques such as damage control laparotomy, staged laparotomy and laparostomy may be required.