Acute necrotic-hemorrhagic pancreatitis is one of the most rare and less remembered causes of acute abdomen in children despite its fatal outcome. We report the case of a 2 year-old girl admitted through accident and emergence department with reported anorexia for 2 weeks, associated with over crying after meals, abdominal distention, vomiting and chills for 2 days. The patient had a temperature of 37.9C, rebound tenderness of the abdomen and absent bowel sounds. Abdominal ultrasonography revealed fluid collection at the pancreatic bed. No focal pancreatic masses or gallstones were reported. Gram staining of peri-pancreatic collection revealed Gram negative rods, whereas its culture revealed Escherichia coli sensitive to gentamycin and ceftriaxone. Other laboratory findings were; hypocalcaemia of 2.0mmol/L, total serum amylase of 350 U/L, Hb of 8.0g/dl and raised ESR of 40mm/hr. Liver and renal function tests were within normal ranges. Enhanced CT scan and serum lipase were unavailable in our settings. We subjected the patient to an emergence exploratory laparotomy. Intraoperative findings were: hemorrhagic ascites, retroperitoneal haematoma, edematous pancreatic body with areas of grey-white necrosis; and steato-necrosis in the omentum and mesentery leading to a diagnosis of acute necrotic-hemorrhagic pancreatitis. We compare the characteristics of our patient with the available data on literature review. Informed consent was sought from the patient’s mother in writing, for the surgery and case documentation.