Severe Necrotizing Pancreatitis in a Pediatric Patient with COVID-19: A Case Report

Abstract

We describe a 15-year-old female diagnosed with necrotizing pancreatitis in the setting of coronavirus disease 2019 with severe complications including splenic vein and portal vein thromboses, pleural effusion requiring chest tube, acute hypoxic respiratory failure requiring noninvasive positive-pressure ventilation, and new-onset insulin-dependent diabetes mellitus, requiring over a month-long hospitalization. Following discharge, the patient experienced a prolonged loss of appetite, nausea, and extreme weight loss., During her prolonged hospitalization, she was diagnosed with necrotizing pancreatitis with walled-off collection which was ultimately treated with transgastric endoscopic ultrasound-guided drainage, multiple endoscopic necrosectomies, lumen-apposing metal stents, and double-pigtail plastic stent. Nine months after her initial presentation, patient's clinical symptoms improved, and her weight stabilized. This case highlights the importance of recognizing acute and necrotizing pancreatitis and its morbidities as complications associated with coronavirus disease 2019.

Keywords: COVID-19; endoscopic necrosectomies; necrotizing pancreatitis.

FIGURE 1.

Radiographic imaging. A) Contrast enhanced helical computerized tomography (CT) scan on the day of presentation shows normal enhancement of the pancreatic head (long arrow) and portal vein at junction with splenic vein (short arrow). B) Image slightly higher shows complete necrosis of the pancreatic body and tail (long arrows) and thrombosis causing filling defect in the portal vein (short arrow). C) Abdominal ultrasound 2 weeks later shows an 11 cm pseudocyst (white arrows) displacing the liver posteriorly (black arrow). D) Another image from the same study shows an 11 cm complex collection in the pancreatic bed consistent with necrosis. E) Axial T2 weighted image rom abdominal magnetic resonance imaging (MRI) almost 14 weeks later shows a persistent large pseudocyst in the right upper quadrant (arrow). F) Axial T2 weighted image higher up shows part of a 21 cm complex peripancreatic collection (long arrow) and residual necrotic pancreatic debris posteriorly (short arrow).

FIGURE 2.

Endoscopic imaging. A) Initial Direct Endoscopic Necrosectomy. Transgastric view of necrotic pancreatic collection through lumen-apposing metal stent featuring solid necrotic debris within cavity. B) Completion of Endoscopic Necrosectomy. Transgastric view of pancreatic collection following removal of the lumen-apposing metal stent with clearance of solid necrotic debris and granular, viable tissue within wall of the collection.