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Friday, December 25, 2020

Necrotizing Pancreatitis

emDocs - December 23, 2020 - By Stephanie Costa, Courtney Cassella
Reviewed by: Skyler Lentz; Brit Long; Alex Koyfman
"Key Points
  • If a patient was previously diagnosed with pancreatitis and is now presenting with clinical worsening, consider necrotizing pancreatitis.
  • CT or MRI with contrast at least 3 days after symptom presentation will give highest yield images for necrotizing pancreatitis diagnosis.
  • Heterogeneous fluid collections and gas within necrotic pancreatic collections may indicate infected necrotizing pancreatitis.
  • Mainstay of management is targeted fluid resuscitation, electrolyte repletion, and analgesia. Vigilance for development of complications and organ failure is paramount.
  • Antibiotics should not be routinely used for sterile necrotizing pancreatitis, but if there is suspicion for infection development, metronidazole, quinolones and carbapenems, specifically imipenem, may be used, but there is limited evidence. Antibiotic usage should be guided by aspiration cultures."