A 38-year-old woman with known gallstones presents with severe epigastric pain radiating to the back, vomiting, and a serum lipase of 1800 U/L (normal <60). On day 3 of admission, CT scan shows a Balthazar grade E finding with 50% pancreatic necrosis. Which intervention is indicated at this point?
- A Immediate surgical necrosectomy
- B Conservative management; necrosectomy only if infected necrosis is confirmed by CT-guided aspiration or clinical deterioration after 4 weeks ✓
- C ERCP and sphincterotomy within 24 hours
- D Prophylactic meropenem for 2 weeks to prevent infection
Correct answer: B. Conservative management; necrosectomy only if infected necrosis is confirmed by CT-guided aspiration or clinical deterioration after 4 weeks
Explanation
Sterile pancreatic necrosis is managed conservatively with IV fluids, nutritional support (enteral preferred), and analgesia. Surgical necrosectomy is reserved for confirmed infected necrosis or clinical deterioration, and current guidelines (IAP/APA) defer intervention to at least 4 weeks to allow the necrosis to liquefy and 'wall off,' enabling safer step-up drainage. Prophylactic antibiotics are not recommended for sterile necrosis.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.