Pancreatic necrosis and infection--an update on management

The mortality rate for acute pancreatitis complicated by necrosis and infection has remained high in spite of progress made in supportive care. This is mostly related to development of multi-organ failure and overwhelming sepsis. Early diagnosis of necrosis and infection followed by correct management are essential for improving survival. Contrast-enhanced computed tomography with the adjunct of fine-needle aspiration is reliable in detecting necrosis and infection. Several surgical treatment modalities are discussed in the literature; however, the cornerstone for improved survival in patients with infected necrosis is adequate debridement and wide drainage. This can be achieved with any modality, provided that the patients are re-explored promptly if the septic status persists.