UMEM Educational Pearls

Title: Source control specifics for intraabdominal infection induced sepsis

Keywords: sepsis, intrabdominal, source control (PubMed Search)

Posted: 11/28/2025 by Robert Flint, MD (Updated: 11/30/2025)
Click here to contact Robert Flint, MD

Intraabdominal infections leading to sepsis can come from cholecystitis, small bowel perforation, gastric perforation, left sided colonic diverticulitis, right sided diverticulitis and appendicitis. When to initiate source control and antibiotics is controversial. These authors propose breaking patient populations into three groups:

Class A Healthy patients have no or else well-controlled comorbidities, and no immunocompromise, so that the IAI is the main problem.
Class B Patients with moderate comorbidities and/or moderate immunocompromise are at risk of adverse outcomes due to their predisposing conditions, but are currently clinically stable. However, the IAI could rapidly worsen the prognosis.
Class C Patients with severe comorbidities with advanced stages and/or severe immunocompromise, in which the infection worsens an already severe clinical condition.

From this they propose algorithms to treat these intraabdominal infections such as (note the different approach to right and left diverticulitis):

References

Coccolini, Federico MD, PhD; Kirkpatrick, Andrew W. CD, MD, MHSc, FRCSC, FACS; Cremonini, Camilla MD, PhD; Sartelli, Massimo MD, PhD. Source control in intra-abdominal infections: What you need to know. Journal of Trauma and Acute Care Surgery 99(5):p 669-678, November 2025. | DOI: 10.1097/TA.0000000000004654