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