skip to main content

Infected pancreatic necrosis — ESEGH MCQ

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

HardPancreatico-biliary DiseaseInfected pancreatic necrosisESEGH

A 44-year-old man has necrotising pancreatitis. On day 16 he develops fever, rising vasopressor requirement and gas within a walled-off pancreatic collection on CT. Blood cultures grow Gram-negative rods. What is the most appropriate management?

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

Reveal the answer and explanation

Correct answer: D — Antibiotics with delayed minimally invasive drainage or necrosectomy using a step-up approach

Infected pancreatic necrosis is suggested by gas and sepsis; management uses antibiotics and a delayed step-up approach with drainage and minimally invasive necrosectomy when possible. Immediate open surgery has higher morbidity and is avoided if less invasive control is feasible. Steroids do not treat infected necrosis. The pearl is that delaying intervention until collections mature often improves outcomes if the patient can be stabilised.

Reference: NICE Pancreatitis Guideline NG104; IAP/APA Acute Pancreatitis Guideline