Protracted hemorrhagic gastritis in an infant recovering from acute pancreatitis--successful management with prostaglandin E2 analogue.

This case report describes the course and management of a 10-week-old boy with idiopathic hemorrhagic pancreatitis who presented initially with ascites. His hospital course was complicated by severe recurrent intraperitoneal bleeding, requiring, in less than 5 days three exploratory laparotomies to control the hemorrhage. In the following 11 weeks he had five major bleeding episodes attributed to ulcers, gastritis, and esophagitis. Continuous infusion of H2 blockers, antacid drip, and sucralfate combined with Nissen fundoplication, elective vagotomy, and pyloroplasty were used unsuccessfully to control the bleeding until a prostaglandin E2 analogue at 18 micrograms/kg/day in four divided doses was given enterally. During the following 19 months, there has been no recurrence of bleeding.