3-YEAR-OLD boy was referred to the pediatric gastroenterology department for evaluation of abdominal pain and vomiting. The patient had a 1-year history of recurrent, acute, episodic abdominal pain that was often associated with vomiting. The episodes occurred infrequently and typically lasted for 48 to 72 hours. There was no nocturnal awakening with abdominal pain or emesis. There was no associated fever, diarrhea, rash, headache, or altered consciousness. The child has main

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A HEALTHY 14-month-old girl was referred for evaluation of hepatomegaly found during a physical examination prompted by accidental trauma of her left wrist. She had no history of jaundice, weight loss, night sweats, fever, or decreased activity. Her medical history was negative for perinatal difficulties, including cardiac abnormality. There was no recent foreign travel, and the family had no pets. The family history was negative for hepatitis, Wilson disease, ␣ 1 -antitrypsin deficiency, storage diseases, or hepatic tumors.Findings from physical examination revealed a welldeveloped infant with height and weight in the 50th percentile. Heart rate, blood pressure, and respiratory rate were normal, as were the retinae on funduscopic examination. No cutaneous lesions or cardiac murmur were present. The liver extended 5 cm to 6 cm below the right costal margin. The spleen was not palpable. The stool was negative for occult blood. Results of laboratory examination showed reference values for hemoglobin, hematocrit, platelet count, white blood cell count, erythrocyte sedimentation rate, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, ␥-glutamyltranspeptidase, bilirubin, and albumin. Abdominal ultrasonogram and computed tomographic scan (with and without intravenous contrast medium) were obtained (Figure 1 and Figure 2). Serum ␣ 1 -fetoprotein levels were normal. A radiolabeled red blood cell scan was unhelpful for diagnosis because of technical difficulties. Repeated ultrasonography and computed tomography were performed 6 months later with no change seen. Figure 1.Figure 2.

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