In suspected pancreatic necrosis, what initial step is often performed before definitive surgery?

• A. Image-guided drainage
• B. Immediate surgery
• C. Observation
• D. Antibiotics alone

Answer: (A)

Managing suspected infected pancreatic necrosis focuses on getting source control first. Instead of rushing to open surgery, clinicians use image-guided percutaneous drainage of the necrotic collection to control sepsis and stabilize the patient. This step-up approach reduces mortality by addressing the infected tissue early while buying time for inflammation to subside and for the necrosis to become more well-defined. Antibiotics are important but alone cannot eradicate infection in necrotic tissue, which is poorly penetrated by antibiotics. If drainage fails to control the sepsis or the patient remains unstable, definitive debridement can be performed later, often using minimally invasive techniques. This approach, supported by studies like the PANTER trial, explains why image-guided drainage is the preferred initial step.