Management of necrotizing pancreatitis

Infection complicating pancreatic necrosis leads to persisting sepsis, mult iple organ dysfunction syndrome and accounts for about half the deaths that occur following acute pancreatitis. Severe cases due to gallstones require urgent - endoscopic sphincterotomy. Patients with pancreatic necrosis shou ld be followed with serial contrast enhanced computed tomography (CE-CT) an d if infection is suspected fine needle aspiration of the necrotic area for bacteriology ( FNAB) should be undertaken. Treatment of sterile necrosis s hould initially be non-operative. In the presence of infection necrosectomy is indicated. Although traditionally this has been by open surgery, minima lly invasive procedures are a promising new alternative. There are many unr esolved issues in the management of pancreatic necrosis. These include, the use of antibiotic prophylaxis, the precise indications for and frequency o f repeat CE-CT and FNAB, and the role of enteral feeding.