Case report: Neonatal Pancreatitis, Chromosomal Abnormality
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Pancreatitis in the paediatric population is not as common as in adults. Neonatal pancreatitis is extremely rare and sparsely reported.

A 39- hour old female neonate of African descent delivered via emergency lower caesarean section at 34 weeks for premature onset of labour in a Hepatitis positive, multiparous mother reported. There was an obstetric history of polyhydramnios and double bubble features in the foetal abdomen on antenatal scans done in the early 3rd trimester.

APGAR Score was queried at 7 [1] and 9 [5] with a weight of 2.1 kg and there was no history of birth trauma. The baby was presented with a history of weak cry, bilious vomiting and abdominal distension starting shortly after birth. Hepatitis B immunoglobulin was administered at birth. On examination, the baby had mottled skin, dysmorphic facie (occipitofrontal circumference of 32 cm), prominent forehead, slanted eyes, low set ears, flattened nasal bridge (with inter canthal distance of 2 cm) and ankyloglossia. Baby was deeply icteric, acyanosed and afebrile. Respiratory rate was 60/min with broncho - vesicular breath sounds, and a grade 3 systolic murmur on auscultation. A diagnosis of neonatal intestinal obstruction secondary to duodenal atresia, keeping in view a perforated viscus from necrotizing enterocolitis on a background of Trisomy 21 in compensated shock was made.

The babygram showed multiple large bubbles and positive Riglers' sign suggestive of pneumoperitoneum though free air under the diaphragm could not be demonstrated despite the large volume of air. Intraoperative findings were of a grossly distended abdomen, significant pneumoperitoneum with the air trapped inside the omentum similar to a helium balloon, cheesy deposits between the leaves of the omentum, the anterior abdominal wall, lesser sac, anterior to and behind the mobilized second part of the duodenum, in the peripancreatic region and on the rest of the bowel loops. The aspirated jejunum contained bile.

After difficulty with advancing fluid past the dilated duodenum freely, an intraoperative diagnosis of annular pancreas with peri-natal pancreatic injury, fat saponification and duodenal stenosis was made. A Diamond duodeno - jejunostomy was done. Intraoperative time was 67 minutes and estimated blood loss was 20mls. She was infused with warmed lactated ringers and 40mls of whole blood intraoperatively.

Post-operatively, treatment regime was continued with the addition of analgesics and lactated ringers. Urine output was adequate but blood tinged. On the post-operative day 2, she was observed to be bleeding from puncture sites and passing blood stained urine. She also suffered an episode of witnessed apnoea. Blood sugar was found to be 28 mg/dl (hypoglycemia). She was resuscitated successfully and her saturation improved to the high 90s.

She was continued on post-operative plans including Vit. K, blood chemistry, platelet transfusion, an echocardiogram, an ENT review (due to a suspicion of a laryngeal web) and endocrinology review. She however developed a fatal cardiac arrest about 8 hours later. Cause of death was ruled as bronchopneumonia with subtotal lung collapse in a background of multiple congenital anomalies and prematurity.