Synopsis
Name pancreatic and peripancreatic collections correctly, distinguish sterile from infected necrosis, identify bleeding or obstructive emergencies and use delayed multidisciplinary step-up treatment when safe.
- Use revised Atlanta terminology: acute peripancreatic fluid collection and pseudocyst contain fluid without necrotic debris; acute necrotic collection and walled-off necrosis contain variable solid necrosis.
- Collections younger than about four weeks usually lack a mature capsule; after maturation, a pseudocyst follows interstitial disease and walled-off necrosis follows necrotising pancreatitis.
- Do not call every post-pancreatitis collection a pseudocyst, because solid debris changes drainage technique, stent choice, infection risk and the possible need for necrosectomy.
Key red flags
New fever, rising support, bacteraemia, gas within necrotic material or decline after initial recovery raises infection and needs urgent pancreatic-MDT management.
Investigation priorities
Define necrosis, collection content, gas, wall maturity, extension, mass effect, vessels and procedural access routes.
Management branches
The patient is improving without sepsis, bleeding, obstruction, uncontrolled pain or nutritional compromise.
- Use accurate Atlanta terminology, record collection age and content, and establish whether the pancreatic duct or surrounding vessels are involved.
- Continue oral or enteral nutrition, analgesia, rehabilitation and cause-directed pancreatitis care without prophylactic antibiotics.
Key medicines
Antibiotics for infected pancreatic necrosisChoose a current microbiology and BNF-directed intravenous regimen, adjusted to cultures, renal function, prior exposure and local resistance surveillance.
Analgesia for collection-related painUse a personalised multimodal regimen from the current BNF and acute-pain service, titrating any opioid with regular functional review.