Paediatric necrotising pancreatitis

Necrotising pancreatitis is a rare but serious complication of acute pancreatitis in children. We report a case of a toddler who presented with a 1 day history of persistent non-bilious vomiting, intermittent pallor and irritability, without fever or diarrhoea. Initial examination was non-specific, but progressive abdominal tenderness and new onset of fever prompted imaging and laboratory investigations. Elevated inflammatory markers and serum lipase, along with contrast-enhanced CT findings, confirmed a diagnosis of necrotising pancreatitis. The patient was transferred to a tertiary hospital, recovering after 9 days of supportive care. Follow-up imaging showed resolution of peripancreatic fluid, and no long-term complications were identified. This unexpected presentation of idiopathic necrotising pancreatitis in a young child emphasises the need for early consideration of acute pancreatitis in paediatric patients with non-specific abdominal symptoms, to avoid delays in diagnosis and treatment.