A patient with necrotizing pancreatitis undergoes CT guided aspiration, which results in growth of E-coli on culture. The most appropriate treatment is:
Exploratory laparotomy The presence of secondary pancreatic infection suspected in patients whose systemic inflammatory response (fever, WBC count or organ dysfunction) fails to resolve, CT-guided aspiration of fluid from pancreatic bed for performance of Gram's stain & culture analysis is of critical impoance. A positive is Gram's stain or culture or identification of gas within pancreas on CT-scan, mandate operative intervention.
Culture appropriate antibiotic therapy
ERCP with sphincterotomy
CT guided placement of drain(s)
Exploratory laparotomy