Pancreatic ascites preceding hemorrhagic pancreatitis in an infant

Pancreatic ascites is rare in infants, especially in the first few months of life. The diagnosis is difficult as the ascitic fluid may have undetectable levels of amylase and lipase until the patient is several months of age. We report the case of an infant who presented at one month of age with pancreatic ascites which progressed to hemorrhagic pancreatitis by two months of age. The infant required three operations in the acute phase of his illness to deal with complications of the pancreatitis as well as angiography with embolization to treat exsanguinating hemobilia from a branch of the gastroduodenal artery. At 10 months of age when he developed recurrent pancreatitis, endoscopic retrograde cholangiopancreatogram (ERCP) revealed a proximal pancreatic ductal stricture which was treated with a partial pancreatic head resection and longitudinal pancreaticojejunostomy (Frey procedure). This report is the youngest patient with pancreatic ascites, hemorrhagic pancreatitis and pancreatic ductal stricture treated with pancreaticojejunostomy. This report illustrates the multidisciplinary approach to the treatment of a rare disease in an infant.