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Is Computerized Tomographic Fine Needle Aspiration Helpful in the Management of Infected Pancreatic Necrosis?

Prior to the technique of CT-guided percutaneous aspiration (CT-FNA) with Gram stain and culture, there was no way to diagnose infected necrosis other than the rare finding of air bubbles within the pancreatic area on CT scan. The extent of leukocytosis or temperature does not reliably distinguish severe sterile from infected necrosis (3). Furthermore, the extent of necrosis, the development of organ failure (or multisystem organ failure), and serum markers are not reliable indicators of infected necrosis (1, 4). Prior to CT-FNA, patients were usually maintained for many weeks on medical management that included antibiotics. By the time surgery was performed, the patient was usually critically ill, and the mortality was high. Mortality of infected necrosis treated nonsurgically was essentially 100%. For the past 20 years, the prevailing concept has been that early recognition of infected pancreatic necrosis followed by prompt surgical debridement is the best way to reduce morbidity and mortality associated with this complication.