Intestinal Perforation and Abdominal Sepsis: Diagnostic Challenges, Timely Surgical Source Control, and Integrated Emergency Management

Intestinal perforation complicated by intra-abdominal infection represents a major challenge in emergency general surgery due to its potential progression to generalized peritonitis, sepsis, septic shock, and multiple organ dysfunction. Early recognition and coordinated therapeutic intervention are essential to address the anatomical and physiological consequences of this condition. This narrative review aimed to analyze the available scientific evidence regarding diagnostic assessment, emergency stabilization, antimicrobial management, and surgical source control, incorporating international recommendations and considerations relevant to Latin American healthcare systems. A descriptive and analytical approach based on the scientific method was adopted to synthesize evidence from clinical guidelines, randomized controlled trials, observational investigations, and multicenter studies. The reviewed literature identified substantial variability in clinical presentation, disease severity, and therapeutic approaches. International multicenter investigations reported mortality rates of approximately 9–11% among patients with complicated intra-abdominal infections, highlighting their considerable clinical burden. Evidence concerning surgical source control emphasized the importance of timely intervention and adequate elimination of the infectious focus, while observational studies associated treatment delays with unfavorable outcomes. Additionally, randomized evidence demonstrated that shorter antimicrobial courses following adequate source control produced clinical outcomes comparable to longer regimens in appropriately selected patients. The findings also highlighted differences in healthcare resources and the challenges of implementing standardized management strategies across diverse institutional environments, particularly in Latin America. Overall, the evidence supports an integrated approach combining early diagnosis, individualized resuscitation, appropriate antimicrobial therapy, definitive source control, and continuous reassessment. Further prospective multicenter research is necessary to clarify optimal intervention timing, strengthen clinical decision-making, and improve the applicability of evidence-based management pathways across different healthcare settings.