Michael Boettcher

Clinical and sonographic features predict testicular torsion in children: a prospective study

To test the clinical and sonographic predictors of testicular torsion (TT) with the aim of reducing negative exploration rates.

Abdominal Wall Incision with or without Exteriorization of Bowel: Results from a Fetal Lamb Model for the Embryogenesis of Gastroschisis

Introduction: The embryogenesis of gastroschisis is not completely understood. The aim of our study was to evaluate the impact of a simple abdominal wall defect versus a defect including eviscerated intestine or omentum for the development of gastroschisis in a fetal lamb model. Material and Methods: At mid-gestation (day 77) an abdominal wall defect was fetoscopically created with three different approaches in 19 German blackhead sheep. The intestine was eviscerated in 7 fetuses (group 1). The peritoneum was incised and a patch of the omentum pulled through the incision in 5 fetuses (group 2). In 7 fetuses (group 3) the skin and rectus muscle were incised until the peritoneum was visible. In this group, no abdominal contents were exteriorized and the peritoneum was left intact. A second fetoscopic procedure was performed 21 days later, assessing the condition and extension of eviscerated bowel. The fetus was retrieved by Cesarean section on day 132 and evaluated. Results: The second fetoscopy acting as a control for the creation of gastroschisis demonstrated eviscerated and inflamed intestine in all 3 groups. The amount of eviscerated intestine did not appear to depend on the size of the defect nor on its duration. Discussion: It appears that a simple incision of the abdominal wall with intact peritoneum is sufficient for the development of gastroschisis in a fetal sheep model. This finding may improve the understanding of the etiology of gastroschisis.

Prenatal latex sensitization in patients with spina bifida: a pilot study.

OBJECT Patients with spina bifida are particularly vulnerable to developing immunoglobulin E (IgE)-mediated latex sensitization. Even though many risk factors leading to latex allergy in these patients have been described, it is still unclear whether the increased prevalence of latex sensitization is disease associated or due to the procedures used to treat spina bifida. The aim of this study was to assess prenatal latex sensitization in patients with spina bifida by examining IgE levels in umbilical cord blood. METHODS Patients with spina bifida and matched healthy infants were recruited from the University Medical Center Hamburg-Eppendorf and Childrens Hospital Altona. Latex-specific and total IgE were assessed in umbilical cord blood using ImmunoCAP testing to evaluate the degree of prenatal latex sensitization. RESULTS Twenty-two subjects, 10 with spina bifida and 12 healthy individuals, were included. Subjects were selected after matching for sex, gestational age, weight, parental allergy profile, number of prenatal examinations, and utilization of latex tools during pregnancy (propensity score estimates, p = 0.36). In patients with spina bifida, latex-specific and total IgE levels were significantly higher than those in healthy individuals (p = 0.001). After normalization to total IgE, latex-specific IgE levels were higher, yet not significantly increased (p = 0.085). CONCLUSIONS Perinatally, there is a significant augmentation of total and latex-specific IgE in patients with spina bifida. After correcting for total IgE, latex-specific IgE was increased, yet not significantly higher than in matched, healthy controls. This pilot study gives novel insights in the immunological reactions related to spina bifida. The increased latex-specific IgE levels could possibly be associated with the occurrence of a latex allergy in the future.

Concomitant bilateral adnexal entanglement in a 7-year-old girl with precocious puberty.

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Currarinot triade: Images for Surgeons

A 14-year-old girl presented with severe abdominal pain and bilious vomiting at our institute. Her symptoms first started 48 h after eating lunch. She had runny bowel movements twice daily; her bowel habits appeared normal to her and her family. Her past medical history included a low imperforate anus and spina bifida with a neurogenic bladder. At a different hospital, she was given oral antibiotics for a suspected urinary tract infection; at no time did she complain of dysuria. On arrival, she complained about worsened abdominal pain. She had mild lower-abdominal tenderness to palpation and rectal examination revealed a stenosed anus. Her vital signs were stable and she was afebrile. Urine analysis and laboratory studies were unremarkable. An abdominal X-ray (Fig. 1) showed massive dilatation of the colorectum and a partial asymmetric deformity of the sacrum. Magnetic resonance imaging (MRI) studies confirmed these findings and revealed a tethered cord. The Currarino triade is a relatively unknown hereditary disorder linked to the 7q36 region. The embryological complex results from an abnormal separation of the neuroectoderm and the endoderm. It is characterized by an anorectal malformation, sacrococcygeal defect, and a presacral mass, like teratoma, hamartoma or anterior spina bifida. The sacral anomaly is typically sickle shaped and is known as scimitar sacrum. In contrast to usual sacrococcygeal teratoma, malignant transformation in Currarino patients is rare (1%). The other associated manifestations include malformations of the urogenital system such as vesicouretral reflux or intraspinal anomalies like spinal cord tethering. Constipation is seen in virtually all patients with Currarino triade. Therefore, constipation cannot be used to diagnose tethered cord syndrome nor to indicate tethered cord release. Diagnosis is sometimes postponed by the absence of sacral defects. In patients with intractable constipation, MRI to rule out anosacral and spinal cord anomalies as well as sacral bony defects is recommended.

Rectum perforation after broomstick impalement in a 17-year-old: case report and review

Abstract Impalement injuries are uncommon, especially in the pediatric population. Because of the rarity of these injuries, physicians may have difficulty recognizing and treating impalement injuries appropriately. Clinical findings are sometimes innocuous, but can be life threatening. Therefore, evaluation of suspected impalement injury should involve careful history and thorough physical examination, even if there is no evidence of trauma to the perineum. We report a very rare case of rectum perforation after transanal introduction of a broomstick with almost no clinical findings. Impalement injuries are difficult to recognize, and severity may not be reflected by their external appearance. To diagnose these injuries in time, it is important to use a well-organized workup.