Objective:

To elucidate the immunological mechanisms underlying the progression from complicated intra-abdominal infection (cIAI) to intra-abdominal sepsis (IAS) and to propose a compartment-oriented immunopathological framework that informs clinical practice.

Key Findings:

• The peritoneal cavity is an active immune compartment with specialized cells that respond rapidly to infections, enabling effective initial containment.
• Inadequate intervention and unfavorable host conditions can lead to excessive inflammation, resulting in progression to IAS.
• cIAI is a significant source of sepsis, accounting for 18-22% of cases globally, highlighting its clinical relevance.

Interpretation:

The findings suggest that understanding the dynamics of peritoneal immune responses can inform better risk stratification and management strategies for patients with cIAI and IAS, ultimately improving patient outcomes.

Limitations:

• The review highlights gaps in understanding the regulation of peritoneal immune responses, particularly in diverse patient populations.
• The complexity of individual patient conditions and responses to treatment may not be fully addressed, indicating a need for further research.

Conclusion:

A deeper understanding of peritoneal immune dynamics is crucial for improving outcomes in patients with cIAI and IAS, emphasizing the need for immunologically informed intervention strategies that can be integrated into clinical practice.