Surgery Research Journal

Persistent Shock After Source Control in Intra- Abdominal Sepsis: A Structured Critical Review and a Time-Triggered Reassessment Algorithm

João Rêgo Araújo,

João Rêgo Araújo

Medical Student, School of Medicine, Universidade Potiguar (UnP), Natal, Rio Grande do Norte, Brazil.

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Amália Cinthia Meneses Rêgo,

Amália Cinthia Meneses Rêgo

Full Professor (Biotechnology), Universidade Potiguar (UnP), Natal, Rio Grande do Norte, Brazil.

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Irami Araújo-Filho

Irami Araújo-Filho

1) M.D., Ph.D. in Health Sciences (Universidade Federal do Rio Grande do Norte, UFRN); Ph.D. in Experimental Surgery (Sorbonne University, Paris). 2) Full Professor, Department of Surgery, Universidade Federal do Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil.

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  10.33425/2768-0428.1055 Published: 03 Sep, 2026
Intra-abdominal sepsis is a frequent and lethal cause of septic shock in critically ill adults, and early, adequate source control is a cornerstone of management. Yet after operative or percutaneous source control, many patients remain in shock in the intensive care unit, occupying a clinical gray zone: residual or recurrent shock may reflect expected postoperative inflammation, vasoplegia, hypovolemia and reperfusion, or it may signal undrained or progressive anatomical disease or microbiological failure. In this structured critical narrative review, reported following SANRA and not a systematic review, we propose that persistent shock after abdominal source control be interpreted as a time-dependent Bayesian signal. We provide operational definitions, distinguish the postoperative inflammatory–hemodynamic trajectory from ongoing disease, and map hemodynamic, metabolic, organ-dysfunction, abdominal, bedside, radiological, microbiological, surgical-context and cognitive triggers, organized into three phases—0–24 h (vigilant tolerance), 24–48 h (inflection point) and 48–72 h (presumed failure zone). Persistent shock is not, by itself, diagnostic of source-control failure, but it should raise the pre-test probability of ongoing anatomical or microbiological disease and trigger structured, interdisciplinary reassessment—re-imaging, antimicrobial review, drainage or reintervention, and formal exclusion of extra-abdominal causes—within 24–72 hours. The 48–72 h window is a safety threshold for mandatory reassessment, not a diagnostic threshold for failure. This hypothesis-generating algorithm is not a validated guideline and does not replace clinical judgment; it may reduce diagnostic inertia, and prospective, multicenter validation is required.
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