Colonic Duplication Cyst with Gastric and Pancreatic Heterotopia: A Case Report

Colonic duplication is an uncommon congenital anomaly within the alimentary tract which may be missed on clinical examination. Clinical symptoms are generally related to the involved site, size of duplication, or the associated ectopic mucosa. This is a case report of a 7-month-old female patient admitted in septic and hypovolemic shock, with severe anemia. Ultrasonography and computed tomography (CT) scans showed a left flank mass suggesting intussusception. The patient was first stabilized with intravenous fluids, intravenous antibiotics, oxygen, and blood transfusion. At laparotomy, the findings were a left paracolic cystic mass and an adjacent, complex retroperitoneal hemorrhagic mass. The histopathology report was consistent with a colonic duplication cyst with ectopic gastric and pancreatic mucosa. The patient improved after surgery and was discharged for routine outpatient follow-up. Colonic duplication should be included in the differential diagnoses in children presenting with palpable abdominal masses. Complete surgical removal of the symptomatic duplication is the treatment of choice

Oral amoxicillin versus benzyl penicillin for severe pneumonia among kenyan children: a pragmatic randomized controlled noninferiority trial.

BACKGROUND: There are concerns that the evidence from studies showing noninferiority of oral amoxicillin to benzyl penicillin for severe pneumonia may not be generalizable to high-mortality settings. METHODS: An open-label, multicenter, randomized controlled noninferiority trial was conducted at 6 Kenyan hospitals. Eligible children aged 2-59 months were randomized to receive amoxicillin or benzyl penicillin and followed up for the primary outcome of treatment failure at 48 hours. A noninferiority margin of risk difference between amoxicillin and benzyl penicillin groups was prespecified at 7%. RESULTS: We recruited 527 children, including 302 (57.3%) with comorbidity. Treatment failure was observed in 20 of 260 (7.7%) and 21 of 261 (8.0%) of patients in the amoxicillin and benzyl penicillin arms, respectively (risk difference, -0.3% [95% confidence interval, -5.0% to 4.3%]) in per-protocol analyses. These findings were supported by the results of intention-to-treat analyses. Treatment failure by day 5 postenrollment was 11.4% and 11.0% and rising to 13.5% and 16.8% by day 14 in the amoxicillin vs benzyl penicillin groups, respectively. The most frequent cause of cumulative treatment failure at day 14 was clinical deterioration within 48 hours of enrollment (33/59 [55.9%]). Four patients died (overall mortality 0.8%) during the study, 3 of whom were allocated to the benzyl penicillin group. The presence of wheeze was independently associated with less frequent treatment failure. CONCLUSIONS: Our findings confirm noninferiority of amoxicillin to benzyl penicillin, provide estimates of risk of treatment failure in Kenya, and offer important additional evidence for policy making in sub-Saharan Africa. CLINICAL TRIAL REGISTRATION: NCT01399723