SURGICAL MANAGEMENT AND FOCUS CONTROL IN THE TREATMENT OF ABDOMINAL SEPSIS

Abstract

Abdominal sepsis represents a dysregulated systemic inflammatory response to an abdominal infectious process, frequently associated with severe organ dysfunction. The aim of this study is to conduct a narrative review of recent evidence on surgical approaches and control of the infectious focus. The search was conducted in the PubMed database, using the descriptors "Sepsis" and "Intra-Abdominal Infections," selecting articles published in the last five years, in English and Portuguese. Physiologically, the intensity of the inflammatory response in abdominal sepsis is influenced by the variation in microorganisms of the intestinal bacterial flora and by the type of content contributing to the response (fecal matter, bile, gastric juice). The increased presence of intraperitoneal enterobacteria, for example, has been documented to exacerbate inflammatory responses. In this context, the cornerstones of treatment are the early initiation of broad-spectrum antibiotic therapy, optimized resuscitation, and the surgical diagnosis and management of the septic focus. Controlling the source of infection is a key determinant of success, and intervention should be early, ranging from minimally invasive techniques to emergency surgery, with the goal of interrupting the source of contamination and reducing the infectious load. Antibiotic therapy should be initiated within the first hour of clinical suspicion, without delay due to laboratory tests, although blood cultures should be performed before administering broad-spectrum antibiotics. Maintaining a good effective circulating volume in the pre-, peri-, and post-operative periods is essential to ensure an adequate hemodynamic profile and good tissue perfusion. This perfusion is crucial for the proper tissue distribution of antibiotics, whose pharmacokinetics can be affected by the pathophysiology of sepsis. In monitoring, markers such as procalcitonin help track the therapeutic response and guide antibiotic therapy, complementing the clinical assessment. Furthermore, the development of organizational models with multidisciplinary teams contributes to reducing the time to intervention and achieving better outcomes. In conclusion, the management of abdominal sepsis requires an integrated and early approach—focused on infection control, rational antimicrobial therapy, and multidisciplinary support—as a fundamental strategy for achieving better outcomes.