Delineating the source of infection as accurately as possible prior to surgery is the primary aim and the first step in managing intra-abdominal infections. In severe abdominal sepsis however, delays in operative management may lead to worse outcomes and early exploration is always recommended when see more peritonitis is suspected even if the source of infection is not recognized pre-operatively with certainty. The diagnosis of intra-abdominal

sepsis is based primarily on clinical assessment. Typically, the patient is admitted to the emergency department with abdominal pain and a systemic inflammatory response, including fever, tachycardia, and tachypnoea. Abdominal rigidity suggests the presence of peritonitis. However, clinical assessment alone is not ACP-196 always reliable in critically ill patients due to a variety of clinical constraints (e.g., impaired consciousness, severe underlying disease, etc.). Hypotension, oliguria, and acute altered mental status are waring signs of the patient’s transition from sepsis to severe sepsis.

Plain abdominal films are often the first imaging obtained for patients presenting with peritonitis. Upright films are useful for identifying free air under the diaphragm (most often on the right side), which can result from perforated viscera. Free air may be present in most cases of anterior gastric and duodenal perforation. However it is much less frequent selleckchem with perforations of the small bowel and colon and is unusual with appendiceal perforation. Cyclic nucleotide phosphodiesterase Abdominal plain films have low sensitivity and specificity, and have, in most cases, been replaced by abdominal computed tomography (CT). However, plain films of the abdomen remain a reasonable initial study for patients with suspected

peritonitis who, on the basis of history and physical examination, are likely candidates for surgical exploration. In this case, abdominal plain films may confirm evidence of perforation in short time. Ultrasonography and computed tomography have become essential diagnostic tools in abdominal sepsis. The diagnostic approach to confirm the source of abdominal infection in septic patients depends largely on the haemodynamic stability of the patient [21]. Critically ill patients who are haemodynamically unstable or have developed severe acute respiratory distress syndrome (ARDS) requiring high-level ventilatory support, are at significant risk during transport to the radiology department In unstable patients who do not undergo an immediate laparotomy and whose critical condition prevents them from leaving ICU for further imaging, ultrasound (US) is the best available imaging modality [22]. It is portable, it can be performed at the bed side, it is reproducible and can be easily repeated. Major drawbacks are ileus and obesity, which may significantly mask the US view. US is also strongly operator-dependent.