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April 1995

Radiological Case of the Month

Arch Pediatr Adolesc Med. 1995;149(4):460-461. doi:10.1001/archpedi.1995.02170160114018

A3 ½-YEAR-OLD BOY presented with a 2-day history of abdominal pain, anorexia, and nonproductive vomiting. There was no history of trauma or previous abdominal surgery. He had previously received a diagnosis of fragile X syndrome.

Examination revealed moderate distension of the abdomen, diminished bowel sounds, and minimal epigastric tenderness. No guarding or rebound tenderness was elicited. A nontender mass was palpated in the right lower quadrant of the abdomen.

Laboratory investigation revealed an elevated leukocyte count of 17×109/L, serum amylase level of 426 U/L (normal, <103 U/L), serum lipase level of more than 90 U/L (normal, <90 U/L), and serum glucose level of 9.2 mmol/L (166 mg/dL). Results of liver function tests and levels of serum cholesterol, triglycerides, and calcium were normal. Twenty-four hours later, his leukocyte count increased to 22×109/L, with 0.9 polymorphonuclear cells. The serum glucose level increased to 12.9 mmol/L (232 mg/dL);