*6.1.2.2 Sterile necrosis*

In patients with necrotizing pancreatitis, sterile necrotizing pancreatitis should be suspected when there is no improvement despite treatment, and no clear clinical or imaging findings of infection. In such cases, FNA sampling is indicated, and if the collected material is sterile, there is no need to continue the ABs. Even ABs cannot prevent sterile necrosis from turning into infected necrosis [47, 52, 94]. In sterile necrosis in the absence of any sign of infection, interventions will be required in the following cases:


*Emergency Management of Acute Pancreatitis DOI: http://dx.doi.org/10.5772/intechopen.95986*

• Disconnected duct syndrome (full transection of the pancreatic duct) with persistent symptomatic collections with necrosis (e.g., pain, obstruction) more than 8 weeks following the onset of acute pancreatitis.

Aside from these, CT and FNA should be repeated 5–7 days later in patients with sterile necrosis detected by CECT and FNA, but with signs of systemic toxicity [48, 52].

The much rarer complications include peripancreatic vascular complications, splanchnic vein thrombosis, abdominal compartment syndrome and pseudoaneurysm. Furthermore, patients may risk developing diabetes in the following periods [27, 52, 95].

### **6.2 Systemic complications**

Respiratuar insufficiency includes pneumonia, atelectasis, and ARDS. Renal complications are prerenal azotemia, hypotansion and acute tubuler necrosis. Shock is caused by third space losses, vomiting and interstitial edema. Hypohyperglicemia, coagulation disorders, fat necrosis and pancreatic encphalophaty are other rare systemic complications of AP [27].
