skip to main content

Infected Pancreatic Necrosis — FRCA Final MCQ

Instant feedback + full explanation. One question, done properly.

ModerateIntensive Care MedicineInfected Pancreatic NecrosisFRCA Final

A 60-year-old man (ASA III) is on the ICU with severe acute pancreatitis. He is intubated and ventilated. On day 5, an abdominal CT shows a 12 cm pancreatic necrosis collection with gas bubbles. What does the presence of gas within the necrotic collection indicate?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Infected pancreatic necrosis

Gas within a pancreatic necrosis collection on CT is pathognomonic of infected pancreatic necrosis. This is a critical turning point in management – infected necrosis has significantly higher mortality than sterile necrosis. Management follows a 'step-up' approach (IAP/APA 2013 guidelines): broad-spectrum antibiotics (carbapenems), followed by minimally invasive percutaneous/endoscopic drainage, and finally surgical necrosectomy if drainage fails. The PANTER trial showed the step-up approach is superior to primary surgery.

Reference: IAP/APA – 2013 – Acute pancreatitis guidelines; van Santvoort HC – 2010 – PANTER trial