A patient with necrotizing pancreatitis undergoes CT guided aspiration, which results in growth of E-coli on culture. The most appropriate treatment is:
Culture appropriate antibiotic therapy
ERCP with sphincterotomy
CT guided placement of drain(s)
Exploratory laparotomy
Exploratory laparotomy The presence of secondary pancreatic infection suspected in patients whose systemic inflammatory response (fever, WBC count or organ dysfunction) fails to resolve, CT-guided aspiration of fluid from pancreatic bed for performance of Gram's stain & culture analysis is of critical impoance. A positive is Gram's stain or culture or identification of gas within pancreas on CT-scan, mandate operative intervention.