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June 1997

Radiological Case of the Month

Author Affiliations

From the Departments of Pediatrics (Drs Van Winckel and Robberecht), Ultrasonography (Dr Afschrift), and Radiology (Dr Smets), University Hospital Ghent, Ghent, Belgium; and the Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (Dr Wood).

Arch Pediatr Adolesc Med. 1997;151(6):621-622. doi:10.1001/archpedi.1997.02170430087017

A 21-month-old boy was referred because of unremitting bilious vomiting and elevated serum amylase and lipase levels. He had been hospitalized 2 weeks earlier because of vomiting and dehydration. He had no fever. According to his parents, vomiting had started abruptly after a fall from a bench on the same day. His medical history was relevant in that at age 8 months he had been hospitalized because of ulcerations on the uvula and palate.

Findings from a clinical examination showed a dehydrated, lethargic boy, with a sunken, supple abdomen, normal peristaltic activity on abdominal auscultation, and no pain on deep abdominal palpation. Laboratory data showed a mild microcytic anemia and elevated levels of serum amylase (964IU/L) and lipase (7581IU/L). Sonographic examination of the abdomen revealed a cystic mass in the epigastric region. Abdominal radiography showed no abnormal findings.

The boy was rehydrated intravenously, and several attempts to start oral or

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