Management of infected necrotizing pancreatitis with open abdomen and negative pressure therapy

Severe acute pancreatitis (SAP) may progress to infected necrotizing pancreatic (INP) and abdominal compartment syndrome (ACS), significantly increasing mortality and requiring prompt intervention. A step-up approach—including percutaneous drainage, endoscopic procedures, and, in severe cases, open surgery with open abdomen management and negative pressure therapy (NPT)—has demonstrated improved outcomes. This article reviews optimal management of complicated SAP and the role of NPT in reducing morbidity and mortality. A 31 years old female developed infected pancreatic necrosis and abdominal compartment syndrome. Initial management included necrosectomy with closed and open drains, followed by primary fascial closure but the patient continued to deterioration. Therefore, she underwent reoperation with surgical debridement and application of NPT technique. The patient recovered without disabling sequelae. Current IPN management prioritizes radiological or endoscopic interventions. However, open abdomen with NPT remains a viable option when minimally invasive approaches fail or are unavailable. Here the NTP shows favorable outcomes despite limited published evidence.