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March 1997

Radiological Case of the Month

Arch Pediatr Adolesc Med. 1997;151(3):311-312. doi:10.1001/archpedi.1997.02170400097017

ATEENAGED girl with cystic fibrosis and diabetes mellitus presented with severe projectile vomiting that had lasted for 4 days. She complained of nausea, early satiety, and bloating. She was completely unable to tolerate solid foods but had some toleration for liquids. Her symptoms included nonradiating epigastric discomfort and a sensation of fullness. The vomitus did not contain blood or bile, and she had a history of regular bowel movements.

Her medical history was significant for chronic pancreatitis and a duodenal ulcer. The ulcer, detected by endoscopy 2 years earlier, responded to treatment with omeprazole. Two months prior to initial examination she was treated for Helicobacter pylori gastritis. Her insulin-dependent diabetes mellitus was adequately controlled, however, she had developed diabetic retinopathy with unilateral blindness. Her medications included pancreatin (Pancrezyme) tablets 3 times per day, 100 U insulin injection and 100 U insulin suspension per day, fat-soluble vitamins, and 20mg omeprazole 4