Pancreas: infected necrosis: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Pancreas: infected necrosis

Sample item

A 45-year-old man recovering from severe necrotising pancreatitis develops fever, leucocytosis and sepsis in week 4. CT shows a walled-off collection with gas bubbles. He is on organ support but stable. What is the best approach?

AERCP with sphincterotomyBAntibiotics alone, without any drainageCAntibiotics with percutaneous or endoscopic drainage, escalating only if neededDImmediate open necrosectomy

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Antibiotics with percutaneous or endoscopic drainage, escalating only if needed

Infected walled-off necrosis is managed with a step-up approach: antibiotics that penetrate pancreatic tissue (such as carbapenems), then percutaneous catheter or endoscopic transluminal drainage, and minimally invasive necrosectomy if there is no improvement. This lowers major complications and mortality compared with primary open necrosectomy. Intervention is ideally delayed until about 4 weeks, when the collection is encapsulated.

Option by option

A. ERCP with sphincterotomy
Sphincterotomy treats ductal obstruction by stones and does not clear necrotic infection.
B. Antibiotics alone, without any drainage
Gas-containing infected necrosis rarely resolves with antibiotics alone, as the collection needs drainage.
C. Antibiotics with percutaneous or endoscopic drainage, escalating only if needed (correct)
Minimally invasive drainage first reduces morbidity and often avoids necrosectomy altogether.
D. Immediate open necrosectomy
Primary open necrosectomy carries higher morbidity and mortality than the step-up approach.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is C, Antibiotics with percutaneous or endoscopic drainage, escalating only if needed. Infected walled-off necrosis is managed with a step-up approach: antibiotics that penetrate pancreatic tissue (such as carbapenems), then percutaneous catheter or endoscopic transluminal drainage, and minimally invasive necrosectomy if there is no improvement.

Why is "ERCP with sphincterotomy" not the answer?

Sphincterotomy treats ductal obstruction by stones and does not clear necrotic infection.

Why is "Antibiotics alone, without any drainage" not the answer?

Gas-containing infected necrosis rarely resolves with antibiotics alone, as the collection needs drainage.

Why is "Immediate open necrosectomy" not the answer?

Primary open necrosectomy carries higher morbidity and mortality than the step-up approach.

What concept does this question test?

It tests Pancreas: infected necrosis in General Surgery. This lowers major complications and mortality compared with primary open necrosectomy. Intervention is ideally delayed until about 4 weeks, when the collection is encapsulated.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Pancreas: infected necrosis?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.