To investigate the diagnosis and treatment of severe acute pancreatitis (SAP) in a child.

Clinical data of a child with SAP admitted to Lanzhou University Second Hospital in February 2023 were retrospectively analyzed. On February 2, 2023, a 10-year-old boy was hospitalized due to "persistent epigastric pain with intermittent vomiting for 2 d after eating greasy food". Physical examination: body temperature of 36.8℃, heart rate of 167 beats/min, respiratory rate of 45/min, blood pressure of 92/52 mmHg (1 mmHg=0.133 kPa). He was unconscious and delirious, manifested with pale face, wet and cold skin all over the body, cyanosis of mouth and lips, and insensitive pupil light reflex. The abdominal muscles of the whole abdomen were tense. He was unable to cooperate with physical examination. No tenderness or rebound pain was observed. The patient showed weakly-positive inspiratory three-concave sign, and low and dull heart sound. Laboratory examination: Scr level of 224.3 μmol/L, amylase level of 1 252 U/L, serum lipase level of >2 000 U/L, lactate dehydrogenase level of 521 U/L, B-type natriuretic peptide of 2 934 pg/mL, WBC of 36.3×10⁹/L, Hb of 157 g/L, Plt of 347×10⁹/L, blood potassium level of 7.83 mmol/L, blood sodium level of 120 mmol/L and blood chlorine level of 87.9 mmol/L, respectively. Abdominal ultrasound demonstrated fatty liver, gallbladder effusion, pancreatic enlargement complicated with peripancreatic effusion. Based on clinical manifestations and detection results, the child was diagnosed with SAP complicated with multiple organ failure, diffuse peritonitis and septic shock.

Upon admission, the child was given with positive pressure ventilation using resuscitation bag, invasive ventilator-assisted ventilation by tracheal intubation, albumin expansion, norepinephrine for increasing blood pressure and epinephrine for strengthening heart function. Continuous renal replacement therapy (CRRT) was delivered after general consultation. Imipenem was given for anti-infection and propofol for sedation. Symptomatic treatment, such as nourishing myocardium, inhibiting acid, inhibiting the secretion of pancreatic enzyme and enema with traditional Chinese medicine, was also delivered. After 2 weeks, the child was given with ventilator weaning after proper improvement, and CRRT was terminated. Enteral nutrition therapy was performed by placing jejunal tube. After 5 d, dark red fluid and bloody stool were discharged via gastrointestinal decompression tube. Gastroscopy showed multiple varicose veins at the gastric fundus and gastric greater curvature, manifested with tortuosity especially at the gastric fundus, and local nodules with a maximum diameter of approximately 1 cm. He was positive for red color sign. After Department of General Surgery consultation, emergent open peripancreatic necrotic abscess resection and splenectomy were performed on February 24, 2023. At postoperative 1 month, the child was discharged after regular anti-infection treatment. After 1-year follow-up, the child resumed normal study and life.

For pediatric SAP, prompt diagnosis and interventions should be delivered to prevent subsequent complications. It's of importance to timely conversion of medical and surgical treatment in the management of pediatric SAP. Prospective multi-center trials are required to formulate evidence-based guidelines and optimize the treatment and management of pediatric SAP.