The key determinant in deciding when to operate in the setting of necrosis of the pancreas is the presence or absence of infection in the necrotic pancreas bed.
Generally, it is advised to do a fine-needle aspiration to determine if bacteria are present. The presence of air in the pancreas on CT scan suggests infection, but this must be confirmed before laparotomy.
Conversely, the absence of air does not rule out infection.
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