Key messages

• The conventional approach of managing intra-abdominal infection may fail in patients with severe peritonitis caused by colonic perforation or leakage of intestinal anastomoses.

• In critically ill patients peritoneal defense mechanisms fail to control infection and may have detrimental effects on the host.

• Diagnostic laparoscopy and peritoneal lavage are useful tools in the diagnosis of intra-abdominal sepsis.

• The ideal operative approach for patients with severe forms of intra-abdominal sepsis has not yet been established. Recovery may depend more upon the ability to restore host defense mechanisms than upon surgical technique.

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