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March 1997

Radiological Case of the Month

Author Affiliations

From the Combined Program in Pediatric Gastroenterology and Nutrition, Children's Hospital and Massachusetts General Hospital (Drs Shah and Levine), and Department of Radiology, Childrens's Hospital, Harvard Medical School, Boston, Mass (Dr Buonomo).

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