Complicated intra-abdominal infections are the second most common cause of septic death in the intensive care unit. Although there have been improvements in the outcome of sepsis regardless of etiology, this is even more striking for intra-abdominal infections. From observation, recent advances in interventional techniques, including more aggressive use of percutaneous drainage of abscesses and use of "open abdomen" techniques for peritonitis, have significantly affected the morbidity and mortality of physiologically severe complicated intra-abdominal infection.