STEP 2Pancreatic and peripancreatic necrosectomydebridement

Debridement and removal of the necrotic tissue (necrosectomy) is done bluntly with the fingers or with a sponge. It is important to break into all the recesses of the cavity as guided by the CT to thoroughly remove the debris and necrotic material, a sample of which should also be sent to bacteriology. Any firm attachments should be clamped and tied or left alone.

The pancreas can be discerned from peripancreatic tissues often only on the basis of its location and consistency. Resection of the pancreas should be done carefully and only if the CT shows pancreatic parenchymal necrosis.

If necrosis extends deep into the perirenal spaces and this cannot be accessed through the mesocolon, the respective paracolic gutters are opened to remove the debris/necrosis.

After completing the necrosectomy/debridement, the pancreatic bed is irrigated with several liters of normal saline.


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