Outpatient Botulinum Injections for Early Obstructive Symptoms in Patients with Hirschsprung Disease.

Creator(s)

Wendy Jo Svetanoff, Children's Mercy Hospital
Kayla B. Briggs, Children's Mercy HospitalFollow
James Fraser, Children's Mercy HospitalFollow
Joseph Lopez, Children's Mercy HospitalFollow
Jason D. Fraser, Children's Mercy HospitalFollow
David Juang, Children's Mercy HospitalFollow
Pablo Aguayo, Children's Mercy HospitalFollow
Richard J. Hendrickson, Children's Mercy HospitalFollow
Charles L. Snyder, Children's Mercy HospitalFollow
Tolulope A. Oyetunji MD MPH, Children's Mercy, Kansas City MOFollow
Shawn D. St Peter, Children's Mercy HospitalFollow
Rebecca M. Rentea, Children's Mercy HospitalFollow

Document Type

Article

Publication Date

1-2022

Identifier

DOI: 10.1016/j.jss.2021.07.017

Abstract

INTRODUCTION: Botulinum toxin (BT) injections may play a role in preventing Hirschsprung associated enterocolitis (HAEC) episodes related to internal anal sphincter (IAS dysfunction). Our aim was to determine the association of outpatient BT injections for early obstructive symptoms on the development of HAEC.

METHODS: A retrospective review of children who underwent definitive surgery for Hirschsprung disease (HSCR) from July 2010 - July 2020 was performed. The timing from pull-through to first HAEC episode and to first BT injection was recorded. Primary analysis focused on the rate of HAEC episodes and timing between episodes in patients who did and did not receive BT injections.

RESULTS: Eighty patients were included. Sixty patients (75%) were male, 15 (19%) were diagnosed with trisomy 21, and 58 (72.5%) had short-segment disease. The median time to pull-through was 150 days (IQR 16, 132). Eight patients (10%) had neither an episode of HAEC or BT injections and were not included in further analysis. Forty-six patients (64%) experienced at least one episode of HAEC, while 64 patients (89%) had at least one outpatient BT injection. Compared to patients who never received BT injections (n = 9) and those who developed HAEC prior to BT injections (n = 35), significantly fewer patients who received BT injections first (n = 28) developed enterocolitis (P < 0.001), with no patient developing more than one HAEC episode.

CONCLUSION: Outpatient BT is associated with decreased episodes of HAEC and increased interval between HAEC episodes requiring inpatient treatment. Scheduling outpatient BT injections to manage obstructive symptoms may be beneficial after pull-through for HSCR.

Journal Title

The Journal of surgical research

Volume

269

First Page

201

Last Page

206

Keywords

Botulinum Toxin; Colorectal Disease; Enterocolitis; Hirschsprung Disease; Pediatrics

Recommended Citation

Svetanoff WJ, Briggs K, Fraser JA, et al. Outpatient Botulinum Injections for Early Obstructive Symptoms in Patients with Hirschsprung Disease. J Surg Res. 2022;269:201-206. doi:10.1016/j.jss.2021.07.017