A 45-year-old man with severe acute necrotising pancreatitis develops fever and rising CRP on day 12. Contrast CT confirms infected pancreatic necrosis. He is haemodynamically stable. Which strategy reflects the currently preferred step-up approach?
- A Percutaneous catheter drainage first, escalating to minimally invasive retroperitoneal debridement if needed ✓
- B Antibiotics alone without any source control
- C Immediate open laparotomy with necrosectomy and wide lavage
- D Early surgical debridement within 24 hours of confirming infection
Correct answer: A. Percutaneous catheter drainage first, escalating to minimally invasive retroperitoneal debridement if needed
Explanation
The step-up approach begins with percutaneous or endoscopic drainage, reserving minimally invasive retroperitoneal debridement for those who fail drainage, and avoids open necrosectomy in most patients. Intervention itself is delayed beyond 4 weeks when feasible to allow liquefaction and wall formation. Open necrosectomy carries high morbidity and mortality, and antibiotics alone cannot sterilise infected necrosis, so source control remains mandatory.
Reference: Sabiston Textbook of Surgery, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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