Patient with acute pancreatitis. Computerized Axial Tomography (CAT) performed 72 hours after admission showed necrosis of 50% of the pancreas. At the 3rd week of admission the patient began with high fever and leukocytosis. Urgent chest X-ray and urinary sediment are requested, both being normal. Indicate the next step to follow:
Although the latest recommendations on the management of severe acute pancreatitis advise against FNA because of the risk of infection of sterile necrosis. Current management is governed by stepwise treatment. In the situation described in the question the current treatment is to start antibiotics and assess response.
Fine needle aspiration of pancreatic necrosis guided by ultrasound or CT.
Bronchoalveolar aspirate, urine culture and blood cultures.
Abdominal MRI.
Urgent cholecystectomy.
Echoendoscopy with puncture of the necrosis.