Paediatric necrotizing pancreatitis.

A 13-year-old boy was admitted with a 7-week history of worsening epigastric pain and vomiting. There was no prior history of similar episodes, jaundice or viral infection. There was no family history of hyperlipidaemia. His only comorbidity was obesity with a body mass index of 36.6 kg/m2. On examination he was tachycardic and tachypnoeic with a tender epigastrium. Blood results showed a leucocytosis, normal liver function tests and normal cholesterol, C-reactive protein and amylase levels. An ultrasound scan was performed but did not reveal any detail because of his body habitus. A computed tomography scan showed a necrotic pancreas and that gallstones were present. The patient deteriorated, becoming increasingly septic, and was transferred across to a paediatric intensive care unit. Initial management consisted of fluid resuscitation, intravenous protein pump inhibitors, intravenous antibiotics, parenteral nutrition and surgical review. He initially responded to treatment, but then deteriorated with wo...