Management of infected pancreatic necrosis includes all of the following except: March 2010

Ans. C: Manage conservatively with antibiotics alone Infection complicating pancreatic necrosis leads to persisting sepsis, multiple organ dysfunction syndrome and accounts for about half the deaths that occur following acute pancreatitis. Severe cases due to gallstones require urgent endoscopic sphincterotomy. Patients with pancreatic necrosis should be followed with serial contrast enhanced computed tomography (CE-CT) and if infection is suspected fine needle aspiration of the necrotic area for bacteriology (FNAB) should be undeaken. If the aspirate is purulent, percutaneous drainage of the infected fluid should be carried out. In the presence of infection and worsening of sepsis despite percutaneous drainage, necrosectomy is indicated. Although traditionally this has been by open surgery, minimally invasive procedures are a promising new alternative. There are many unresolved issues in the management of pancreatic necrosis. These include, the use of antibiotic prophylaxis, the precise indications for and frequency of repeat CE-CT and FNAB and the role of enteral feeding. Nutritional suppo is essential