Pancreatic Cystosis Complicating Cystic Fibrosis

A 16-year-old African American boy with cystic fibrosis presented with a 3-day history of abdominal pain, constipation, and increased cough. The pain was poorly characterized, diffuse, and continuous, without exacerbating or relieving factors. He denied nausea and vomiting, but did report recent onset of anorexia with a 4-pound weight loss. He reported worsening constipation, with no bowel movement for 3 days despite increasing doses of milk of magnesia. Past medical history was significant for cystic fibrosis, pancreatic insufficiency, pulmonary disease, and severe constipation. Past surgical history revealed no abdominal surgeries. Medications included pancreatic enzyme supplements, proton-pump inhibitor, β-agonist, fat-soluble vitamin supplements, dornase alpha, and inhaled tobramycin. Physical examination was significant for diffuse abdominal tenderness to light palpation; no hepatosplenomegaly or masses were felt. Pulmonary examination revealed poor respiratory effort but clear breath sounds.