Abstract
You are asked to evaluate a patient who was admitted for alcohol-induced pancreatitis. The patient has had a smoldering course despite aggressive resuscitation and is, currently, febrile and toxic while receiving broad-spectrum antimicrobial therapy. Physical examination demonstrates midepigastric tenderness on moderate palpation. Computed tomography scan findings are consistent for necrotizing pancreatitis. The white blood cell count has increased from 12,000 to 16,000 over the past 48 hours.Which of the following is the most prudent management plan at this time? (A) Continued medical management (B) Peritoneal lavage (C) Computed tomography - directed biopsy of the necrotic tissue for confirmation of infectious etiology (D) Celiotomy (E) Administration of octreotide