Atypical presentation of necrotising pancreatitis in early adolescence

Necrotising pancreatitis (NP) is a severe form of acute pancreatitis (AP), occurring in <1% of cases and associated with significant morbidity.An early adolescent presented with a 48-hour history of abdominal pain and vomiting. On arrival, he was tachycardic and pale with distractible abdominal tenderness but normotensive and afebrile. Initial blood glucose was 41.6 mmol/L, ketones 0.5 mmol/L, pH 7.36 and lactate 7.7 mmol/L. Laboratory investigations showed elevated haemoglobin (Hb), white cell count (WCC) and neutrophils, acute kidney injury (AKI), with a normal glycated haemoglobin (HbA1c) and amylase.He was initially treated with intravenous (IV) fluids and sliding scale insulin. Imaging revealed radiological features consistent with severe NP. He was commenced on Creon and insulin for pancreatic failure. He has subsequently developed acute recurrent pancreatitis.No underlying cause for his presentation has been identified, and he is being considered for total pancreatectomy.This case highlights the importance of maintaining a broad differential diagnosis in the assessment of abdominal pain in paediatric patients. Prompt diagnosis and timely interventions are essential to reduce the risk of potentially significant consequences in NP.