Summary Intraabdominal abscess induced multiple organ failure in 21 patients. Sepsis was most often due to perforation of the colon and was located with almost equal frequency in the upper and lower abdomen. Four patients died after single laparotomy for drainage. Seventeen were drained operatively more than once (average 3.4 operations) at mean intervals of 10 days. Sixteen of the 21 patients (76 percent) died with multiple organ failure despite drainage. Organ function improved temporarily in only one patient. Autopsy showed that pus had persisted or recurred in three patients. No significant predictors of survival were identified, although the advantage appears to lie with the younger patient in whom multiple organ failure develops relatively late after sepsis (mean 13 days) and who needs ventilatory assistance for less than 1 week. The location, size, and bacteriologic characteristics of abscesses do not appear to influence outcome. This study shows that early and repeated drainage of intraabdominal pus will not reverse multiple organ failure in the majority of patients.