{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T14:28:22Z","timestamp":1787149702135,"version":"build-2736575974"},"reference-count":25,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,7,28]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:p>Necrotising pancreatitis (NP) is a severe form of acute pancreatitis (AP), occurring in &lt;1% of cases and associated with significant morbidity.<\/jats:p>\n                  <jats:p>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\u2009mmol\/L, ketones 0.5\u2009mmol\/L, pH 7.36 and lactate 7.7\u2009mmol\/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.<\/jats:p>\n                  <jats:p>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.<\/jats:p>\n                  <jats:p>No underlying cause for his presentation has been identified, and he is being considered for total pancreatectomy.<\/jats:p>\n                  <jats:p>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.<\/jats:p>","DOI":"10.1136\/bcr-2025-271837","type":"journal-article","created":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T14:00:32Z","timestamp":1787148032000},"page":"e271837","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Atypical presentation of necrotising pancreatitis in early adolescence"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-1520-8146","authenticated-orcid":false,"given":"Declan Thomas","family":"Vardy","sequence":"first","affiliation":[{"name":"Paediatrics, Harrogate District Hospital, Harrogate, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdunasr","family":"Alaber","sequence":"additional","affiliation":[{"name":"Paediatrics, Harrogate District Hospital, Harrogate, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6173-5759","authenticated-orcid":false,"given":"Anne","family":"MacCafferty","sequence":"additional","affiliation":[{"name":"Paediatrics, Harrogate District Hospital, Harrogate, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Heddy","sequence":"additional","affiliation":[{"name":"Paediatrics, Harrogate District Hospital, Harrogate, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley","family":"Uttley","sequence":"additional","affiliation":[{"name":"Paediatrics, Harrogate District Hospital, Harrogate, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robyn","family":"Smith","sequence":"additional","affiliation":[{"name":"Paediatrics, Harrogate District Hospital, Harrogate, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"key":"2026081907001500000_19.8.e271837.1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2018.01.032"},{"key":"2026081907001500000_19.8.e271837.2","doi-asserted-by":"crossref","first-page":"1218","DOI":"10.1148\/rg.345130012","article-title":"Necrotizing pancreatitis: diagnosis, imaging, and intervention","volume":"34","author":"Shyu","year":"2014","journal-title":"Radiographics"},{"key":"2026081907001500000_19.8.e271837.3","unstructured":"Takhar M , Mullikin A , Melgar T . Acute pancreatitis in children and adolescents. Nova Science Publishers, Inc, 2018: 151\u201375."},{"key":"2026081907001500000_19.8.e271837.4","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1016\/j.jpeds.2012.09.037","article-title":"Acute necrotizing pancreatitis in children","volume":"162","author":"Raizner","year":"2013","journal-title":"J Pediatr"},{"key":"2026081907001500000_19.8.e271837.5","unstructured":"BSPGHAN . Guidelines for the diagnosis and management of pancreatitis in children. British Society of Paediatric Gastroenterology, Hepatology and Nutrition; 2024. Available: https:\/\/bspghan.org.uk\/wp-content\/uploads\/2024\/04\/guidelines-for-the-diagnosis-and-management-of-pancreatitis-in-children.pdf"},{"key":"2026081907001500000_19.8.e271837.6","doi-asserted-by":"publisher","DOI":"10.1038\/s41575-018-0087-5"},{"key":"2026081907001500000_19.8.e271837.7","doi-asserted-by":"publisher","DOI":"10.1186\/s12876-021-01693-w"},{"key":"2026081907001500000_19.8.e271837.8","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1016\/j.amjsurg.2020.08.027","article-title":"Necrotizing pancreatitis: A review for the acute care surgeon","volume":"221","author":"Leonard-Murali","year":"2021","journal-title":"Am J Surg"},{"key":"2026081907001500000_19.8.e271837.9","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1016\/j.jped.2018.06.011","article-title":"Acute pancreatitis and recurrent acute pancreatitis: an exploration of clinical and etiologic factors and outcomes","volume":"95","author":"Fonseca Sep\u00falveda","year":"2019","journal-title":"J Pediatr (Rio J)"},{"key":"2026081907001500000_19.8.e271837.10","doi-asserted-by":"crossref","DOI":"10.1136\/bmjpo-2022-001487","article-title":"Acute pancreatitis in children - Morbidity and outcomes at 1 year","volume":"6","author":"Bhanot","year":"2022","journal-title":"BMJ Paediatr Open"},{"key":"2026081907001500000_19.8.e271837.11","doi-asserted-by":"crossref","first-page":"061","DOI":"10.29328\/journal.japch.1001020","article-title":"A rare case of acute necrotising pancreatitis in a paediatric patient","volume":"3","author":"Jansen","year":"2020","journal-title":"J Adv Pediatr Child Health"},{"key":"2026081907001500000_19.8.e271837.12","doi-asserted-by":"crossref","first-page":"5639","DOI":"10.1097\/MS9.0000000000002456","article-title":"Necrotizing pancreatitis in an 8-year-old girl: a case report from Nepal","volume":"86","author":"Jha","year":"2024","journal-title":"Annals of Medicine & Surgery"},{"key":"2026081907001500000_19.8.e271837.13","doi-asserted-by":"crossref","first-page":"42","DOI":"10.21304\/2018.0506.00443","article-title":"Idiopathic acute necrotizing pancreatitis\u202f: A case report","volume":"5","author":"Rajan","year":"2018","journal-title":"J Pediatr Crit Care"},{"key":"2026081907001500000_19.8.e271837.14","first-page":"153","article-title":"Wanneer diabetische ketoacidose zich manifesteert als acute buik","volume":"144","author":"Van de Laak","year":"2000","journal-title":"Ned Tijdschr Geneeskd"},{"key":"2026081907001500000_19.8.e271837.15","doi-asserted-by":"crossref","first-page":"S238","DOI":"10.14309\/00000434-200809001-00615","article-title":"Acute Necrotizing Pancreatitis with Normal Amylase & Lipase","volume":"103","author":"DiGiacomo","year":"2008","journal-title":"Am J Gastroenterol"},{"key":"2026081907001500000_19.8.e271837.16","doi-asserted-by":"crossref","first-page":"89","DOI":"10.5152\/TurkArchPediatr.2022.22130","article-title":"Acute Pancreatitis and Acute Recurrent Pancreatitis in Children: Imaging Findings and Outcomes","volume":"58","author":"Ayaz","year":"2023","journal-title":"Turk Arch Pediatr"},{"key":"2026081907001500000_19.8.e271837.17","doi-asserted-by":"crossref","first-page":"S316","DOI":"10.1016\/j.jacr.2019.05.017","article-title":"ACR Appropriateness Criteria\u00ae Acute Pancreatitis","volume":"16","author":"Porter","year":"2019","journal-title":"J Am Coll Radiol"},{"key":"2026081907001500000_19.8.e271837.18","doi-asserted-by":"crossref","first-page":"5268","DOI":"10.3748\/wjg.v29.i37.5268","article-title":"Acute pancreatitis: A review of diagnosis, severity prediction and prognosis assessment from imaging technology, scoring system and artificial intelligence","volume":"29","author":"Hu","year":"2023","journal-title":"World J Gastroenterol"},{"key":"2026081907001500000_19.8.e271837.19","doi-asserted-by":"crossref","first-page":"2702","DOI":"10.1016\/j.cgh.2022.12.015","article-title":"Comments on Association of Chronic Pancreatitis Pain Features With Physical, Mental, and Social Health","volume":"21","author":"Yi","year":"2023","journal-title":"Clin Gastroenterol Hepatol"},{"key":"2026081907001500000_19.8.e271837.20","doi-asserted-by":"crossref","first-page":"1326837","DOI":"10.3389\/fmicb.2023.1326837","article-title":"Viral pancreatitis: research advances and mechanisms","volume":"14","author":"Yu","year":"2024","journal-title":"Front Microbiol"},{"key":"2026081907001500000_19.8.e271837.21","doi-asserted-by":"publisher","DOI":"10.1097\/MOG.0b013e328349e2f8"},{"key":"2026081907001500000_19.8.e271837.22","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1016\/j.pan.2022.06.258","article-title":"Loss-of-function variant in chymotrypsin like elastase 3B (CELA3B) is associated with non-alcoholic chronic pancreatitis","volume":"22","author":"T\u00f3th","year":"2022","journal-title":"Pancreatology"},{"key":"2026081907001500000_19.8.e271837.23","doi-asserted-by":"crossref","DOI":"10.3390\/jcm14072150","article-title":"Endoscopic Management of Recurrent Acute Pancreatitis","volume":"14","author":"Testoni","year":"2025","journal-title":"J Clin Med"},{"key":"2026081907001500000_19.8.e271837.24","doi-asserted-by":"crossref","first-page":"3790","DOI":"10.1111\/ajt.16723","article-title":"Total pancreatectomy with islet cell autotransplantation in a 2-year-old child with hereditary pancreatitis due to a PRSS1 mutation","volume":"21","author":"Marfil-Garza","year":"2021","journal-title":"Am J Transplant"},{"key":"2026081907001500000_19.8.e271837.25","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1016\/j.cgh.2016.02.027","article-title":"Total Pancreatectomy With Islet Autotransplantation Improves Quality of Life in Patients With Refractory Recurrent Acute Pancreatitis","volume":"14","author":"Bellin","year":"2016","journal-title":"Clin Gastroenterol Hepatol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-271837","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T14:00:35Z","timestamp":1787148035000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-271837"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":25,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8,19]]},"published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1136\/bcr-2025-271837"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-271837","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]}}}