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Infected Pancreatic Necrosis — RACP Adult Medicine MCQ

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HardGastroenterologyInfected Pancreatic NecrosisRACP Adult Medicine

A 55-year-old man presents with acute severe pancreatitis complicated by infected pancreatic necrosis (confirmed by FNA showing gram-negative rods). He has been on meropenem for 7 days with no clinical improvement. CT shows walled-off necrosis with gas. Temperature is 39°C. What is the most appropriate next step?

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Correct answer: D — Step-up approach: percutaneous drainage first

Infected pancreatic necrosis not responding to antibiotics requires intervention. The step-up approach (PANTER trial) starts with percutaneous catheter drainage, with escalation to minimally invasive necrosectomy (video-assisted retroperitoneal or endoscopic) only if drainage fails. This approach reduces new-onset organ failure and mortality compared to primary open necrosectomy.

Reference: GESA – 2024 – Infected Pancreatic Necrosis; PANTER Trial; IAP/APA 2024