Serious intra-abdominal infections continue to plague patients and vex surgeons and other caregivers. The mortality rate can exceed 20%, and the morbidity associated with severe cases (eg, enterocutaneous fistula, ventral hernia resulting from open-abdomen management) requires reoperation and months of convalescence. There is no consensus as to the definition of severity and a paucity of studies that focus on treatment at the severe end of the spectrum. Attempts are being made to address the adequacy of operative management (adequacy of "source control") in the context of randomized antibiotic trials. The surgical procedure is the primary treatment modality for most types of intra-abdominal infection, whereas antibiotic therapy is usually adjunctive. It remains to be determined whether the adequacy of source control can be quantified meaningfully.