[Current approach to pancreatic necrosis]

The incidence of acute pancreatitis is increasing. Necrosis occurs in 10 to 20% of the cases, and is associated with great morbidity and mortality. The diagnosis of pancreatic necrosis can be suspected clinically and biochemically, and confirmed with imaging methods. A computerized tomography with contrast injection (dynamic pancreatography) is the best diagnostic method. Treatment of pancreatic necrosis is primarily conservative. Prophylactic antibiotic therapy is reserved for the biliary pancreatitis and for severe cases. When pancreatic infection is suspected, computerized tomography or ultrasonic exam guided percutaneous aspirative punction must be performed, with Gram stain and culture of the material aspirated. If bacterial infection is present, adequate antibiotic therapy with good penetration in necrotic tissue must be provided associated with surgical necrosectomy and local washing or open drainage.