[Infected pancreatic necrosis: Treatment with antibiotics alone. Would this be the first step of the step-up approach?]

Introduction: In 1994, Claudio Bassi reported a case of medical treatment for infected pancreatic necrosis (IPN); then since 1996 numerous articles of case series were published with treatment only with antibiotics with good outcomes.
Objectives: To present our experience in the management of patients with IPN with antibiotics (without drainage).
Methods: We retrospectively reviewed cases with a diagnosis of IPN from January 2018 to October 2020, focusing on those cases that were treated conservatively (hydro-electrolyte, nutritional support and antibiotics). The diagnosis was made by observing gas in the retroperitoneum by CT or by clinical deterioration of the patient with pancreatic necrosis without another focus. Fine needle aspiration was not performed.
Results: We identified 25 patients with a diagnosis of IPN; eleven were treated conservatively. According to Atlanta, modified in 2012, 3 were classified severely and the rest moderately severe. All received antibiotics for at least 3 weeks. None required parenteral nutrition. The mean hospital stay was 38 days. Three patients were readmitted. 8 underwent cholecystectomy after having resolved the condition; the rest were already cholecystectomized. There were no deaths in this series.
Conclusions: IPN can be treated conservatively without drainage with good results in selected cases.