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Biliary colic — USMLE Step 3 MCQ

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HardSurgery (post-operative, follow-up)Biliary colicUSMLE Step 3

A patient with necrotizing pancreatitis develops fever and gas within a walled-off collection 5 weeks after onset. He is hemodynamically stable after antibiotics. What is the preferred next intervention?

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Correct answer: E — Use image-guided or endoscopic drainage as the first step-up intervention

The best answer is “Use image-guided or endoscopic drainage as the first step-up intervention”. Gas and sepsis indicate infected pancreatic necrosis. Because the collection is mature and the patient is stable, minimally invasive drainage is the first source-control step; necrosectomy follows only if needed. Delaying debridement and using a step-up approach reduce morbidity compared with early open surgery.

Reference: AGA Clinical Practice Update: Management of Pancreatic Necrosis: https://pubmed.ncbi.nlm.nih.gov/31479658/