In acute pancreatitis, the overflowing pancreatic fluid contains a large amount of pancreatic enzymes that spread along the tissue interstices and leak under the skin to dissolve the subcutaneous fat, causing the capillaries to rupture and bleed, and the skin around the umbilicus appears blue-purple called Cullen’s sign. What are the symptoms that are easily confused with it? 1, hemorrhagic necrotizing pancreatitis systemic symptoms are critical, starting with irritability, followed by hypotension, shock, dyspnea, oliguria or anuria, severe abdominal pain, inconsistent with the signs of abdominal pain, periumbilical and supraumbilical pressure pain and signs of peritoneal irritation. The former is called Cullen’s sign and the latter is GreyTurner’s sign, which is caused by capillary hemorrhage due to the overflowing pancreatic fluid penetrating the abdominal and lumbar muscles and breaking down the subcutaneous fat. 2, edematous pancreatitis The main symptom is pain in the upper abdomen, mostly persistent, and often accompanied by nausea and vomiting. The vomit is food and gastric and duodenal secretions. The more severe cases are accompanied by abdominal distension, epigastric pain (left or right of the umbilicus) is the only abdominal sign, some children with local muscle tension. 3, biliary acute pancreatitis Biliary acute pancreatitis refers to biliary stones, inflammation and other causes of pancreatic duct obstruction, pancreatic mucosal barrier damage, pancreatic fluid overflow, pancreatic tissue self-digestion, the formation of acute biliary pancreatitis. Its incidence is clinically high, second only to acute appendicitis, acute intestinal obstruction, acute biliary tract infection and gastroduodenal ulcer. 4, pediatric acute pancreatitis Acute pancreatitis is a chemical inflammation-based disease in which the pancreas digests itself due to various causes of pancreatic digestive enzymes being activated in the pancreas. It has various causes and is associated with the spillage of pancreatic fluid into the interstitium of the pancreas and its surrounding tissues, and is often overlooked or misdiagnosed in the early stages of the disease. The common features are sudden onset of severe epigastric pain, vomiting and increased serum amylase. The onset of the disease can be clinically classified into two categories, mild and severe, depending on its severity. Acute pancreatitis is uncommon in the pediatric period, but can occur in the neonatal period. The presentation of acute pancreatitis in newborns is similar to that of other age groups, except that abdominal pain cannot be stated and there may be deepening jaundice and abdominal distention.