Background : Acute necrotizing pancreatitis (ANP) is an uncommon but potentially life-threatening condition in adolescents. We present a case report of a 15-year boy diagnosed with acute necrotizing ANP, managed conservatively initially ,later underwent minimally invasive retroperitoneal necrosectomy.

Methods : The patient presented to ER with severe abdominal pain, nausea, and vomiting. Labs revealed elevated serum amylase ,lipase .CECT showed acute pancreatitis with necrosis. He was admitted in ICU resuscitated with mechanical ventilation, IV fluids and nutritional support. Despite initial Medical management, there's progression of pancreatic necrosis, leading to persistent sepsis and MODS. Serial CECT showed infected pancreatic necrosis. He underwent USG guided pigtail insertion, however no improvement. A minimally invasive retroperitoneal necrosectomy was performed to remove the necrotic tissue and drain the peripancreatic collections.

Results : Following Surgery patient's clinical status improved . Good post-operative care, including nutritional support and close monitoring for any potential complications . During the course of recovery, imaging showed a gradual resolution of the necrotic areas and reduction in size of peripancreatic collections. This case report highlights the challenges in managing ANP in pediatrics and the importance of early recognition and prompt intervention. While conservative management remains first-line approach, surgical intervention, such as minimally invasive retroperitoneal necrosectomy, may be required in refractory cases.

Conclusions : Minimally invasive procedures are suitable alternatives especially in critically ill patients providing lower morbidity and mortality rates. Further research is needed to better understand the etiology and risk factors for ANP in adolescents and to explore optimal treatment approaches that may improve outcomes in this age group