Newer concepts in intra-abdominal infection.

This essay has been delivered as the William H. Harridge, Jr., M.D. Memorial Lecture at the Annual Meeting of the Midwest Surgical Association on Mackinac Island, Michigan, August 20, 1984. The subject of intra-abdominal infection has been reviewed in the light of newer diagnostic and therapeutic modalities. Suspicion for postoperative, posttraumatic, or primary intra-abdominal infection can be raised if one is sensitive to the "soft signs of sepsis" that may herald early organ system derangement prior to the cascade of overt failure. If investigation into the site of infection and its cause can be carried out expeditiously, the appropriate therapeutic maneuver, whether by percutaneous drainage, open drainage, or a correction of the underlying source can be chosen. This essay has presented the newer methods of abscess localization including radionuclide scans, ultrasonography, and computed tomography. The most effective and accurate diagnostic method for disclosing an intra-abdominal abscess appears to be computed tomography (CT). The indications and anticipated success of percutaneous drainage by CT guidance has been presented. The field continues to evolve.