Ectopic Variceal Bleeding From Chronic Superior Mesenteric Vein Thrombosis After Hemorrhagic Pancreatitis

Varices are a common cause of gastrointestinal bleed, but a small percentage of these bleeds are due to ectopic varices. This case presents bleeding ectopic varices in the third part of the duodenum with portal hypertension secondary to chronic superior mesenteric vein thrombosis that developed after hemorrhagic pancreatitis.

EP.FRI.86 Spontaneous haemoperitoneum due to acute hemorrhagic pancreatitis in a child: A Case report

Introduction Hemoperitoneum resulting from acute pancreatitis (AP) is rare. It is more commonly associated with chronic pancreatitis. Seldom, it has been associated with paediatric population. Here we report a case of spontaneous hemoperitoneum due to acute hemorrhagic pancreatitis in a child presented with the clinical features suggestive of acute appendicitis. Presentation of the case A 9-year old girl presented with abdominal pain and clinical features consistent with perforated appendicitis, underwent diagnostic laparoscopy. This revealed hemoperitoneum due to acute hemorrhagic pancreatitis with fat saponification in the omentum around the splenic flexure. She was stable postoperatively and was transferred to a tertiary paediatric unit for further management. Discussion The incidence of paediatric AP is increasing at 1/10,000 children per year. The definition of paediatric AP is based on the Atlanta criteria in adults. Biliary condition, systemic illness, and medications remain the main causes of AP in children. Intravenous fluid therapy with crystalloids remains the mainstay of treatment. Conclusion A high index of suspicion is required to reach the diagnosis as symptoms are commonly comprised of abdominal pain, irritability, nausea, vomiting, and epigastric pain. USS is the investigation of choice. Majority of the patient recovers completely with a recurrence reported only on 15-35% of the cases. Key Statement Inclusion of amylase or lipase to be considered in the routine workup if there is a suspicion of an alternate diagnosis. Diagnostic laparoscopy remains a viable option for patients presented with features of peritonism to establish a diagnosis.

486 Spontaneous haemoperitoneum due to acute hemorrhagic pancreatitis in a child: A Case report

Introduction Hemoperitoneum resulting from acute pancreatitis (AP) is rare. It is more commonly associated with chronic pancreatitis. Seldom, it has been associated with paediatric population. Here we report a case of spontaneous hemoperitoneum due to acute hemorrhagic pancreatitis in a child presented with the clinical features suggestive of acute appendicitis. Presentation of the case A- 9-year-old girl presented with abdominal pain and clinical features consistent with perforated appendicitis, underwent diagnostic laparoscopy. This revealed hemoperitoneum due to acute hemorrhagic pancreatitis with fat saponification in the omentum around the splenic flexure. She was stable postoperatively and was transferred to a tertiary paediatric unit for further management. Discussion The incidence of paediatric AP is increasing at 1/10,000 children per year. The definition of paediatric AP is based on the Atlanta criteria in adults. Biliary condition, systemic illness, and medications remain the main causes of AP in children. Intravenous fluid therapy with crystalloids remains the mainstay of treatment. Conclusions A high index of suspicion is required to reach the diagnosis as symptoms are commonly comprised of abdominal pain, irritability, nausea, vomiting, and epigastric pain. USS is the investigation of choice. Majority of the patient recovers completely with a recurrence reported only on 15-35% of the cases. Key Statement Inclusion of amylase or lipase to be considered in the routine workup if there is a suspicion of an alternate diagnosis. Diagnostic laparoscopy remains a viable option for patients presented with features of peritonism to establish a diagnosis.