A 65-year-old man is in the surgical intensive care unit with acute alcohol-induced pancreatitis with acute fluid collections and necrosis. He subsequently develops fever and leukocytosis, and repeat computed tomography confirms infected pancreatic necrosis with air pockets in the pancreatic bed. He is managed with nasojejunal enteral nutrition, antibiotics, and percutaneous drainage. What is the ideal timing of debridement to optimize this man’s outcome?
A. At the time of diagnosis of infected pancreatic necrosis
B. Prior to percutaneous drainage
C. 7 days after diagnosis
D. 14 days after diagnosis
E. More than 30 days after diagnosis
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A 60-year-old woman with a long history of chronic pancreatitis is referred for surgical evaluation. She has daily debilitating abdominal pain. A computed tomography scan of the abdomen and pelvis demonstrates an inflammatory pancreatic head mass with a dilated pancreatic duct. Endoscopic ultrasound with biopsy of the pancreatic head shows rare atypical cells but no definitive malignant cells. What operative approach is indicated?
A. Beger
B. Frey
C. Distal pancreatectomy
D. Longitudinal pancreatojejunostomy
E. Pancreatoduodenectomy
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