Presenter Status
Fellow
Abstract Type
Research
Primary Mentor
Rebecca M Rentea, MD MS
Start Date
12-5-2021 12:45 PM
End Date
12-5-2021 1:00 PM
Presentation Type
Oral Presentation
Description
Background: Hirschsprung associated enterocolitis (HAEC) is a potentially life-threatening complication, where the child often presents with obstructive symptoms. Failure of the internal anal sphincter (IAS) to relax is thought to play a role in these symptoms. Botulinum toxin (BT) injections assist in temporarily relieving obstructive symptoms due to IAS achalasia in patients with Hirschsprung’s disease following surgical pull-through. The use of BT may play a role in preventing HAEC episodes related to IAS dysfunction.
Objectives/Goal: Our aim was to determine the effect of scheduled outpatient Botulinum injections on the development of HAEC.
Methods/Design: A retrospective review between July 2010 – July 2020 of children diagnosed with Hirschsprung’s disease who had already undergone their pull-through procedure was performed. Our comprehensive colorectal center, which was formulated in July 2018 helps triage patient phone calls and provides parental education about HAEC. Demographic information, the timing from pull-through to first HAEC episode and to first BT injection was recorded for analysis. Our primary analysis was to compare the rate of enterocolitis episodes and timing between episodes in patients who did and did not receive outpatient BT injections. A p-value < 0.05 was considered significant.
Results: 80 patients were initially identified; 75% were male, 69% Caucasian, and 73% had short segment disease. 45% of patients underwent a Swenson procedure, while 39% underwent a Soave procedure for definitive pull-through. Median time to pull-through was 150 days (IQR 16, 132). Eight patients were excluded from further study as no episode of HAEC or use of BT injections occurred during the study period. 46 of the 72 remaining patients (64%) developed at least one episode of enterocolitis, while 64 patients (89%) had at least one outpatient BT injection for early obstructive symptoms. The median time to first enterocolitis episode following pull-through was 71 days (IQR 16, 443), while the median time from pullthrough to BT injection was 486 days (IQR 91, 1325). Sub-analysis was performed based on the timing of the enterocolitis episode with the performance of BT injections. Nine patients required inpatient admission for enterocolitis and have never received outpatient BT injections, 35 patients developed at least one episode of enterocolitis requiring inpatient admission prior to receiving BT injection, and 28 patients underwent BT injections prior to any episodes of enterocolitis. Significantly fewer patients who received BT first developed enterocolitis (p
Conclusions: The use of outpatient BT injections decreases episodes of Hirschsprung associated enterocolitis and increases the interval between recurrent episodes. The development of a multidisciplinary colorectal center that provides parental education and frequent contact with families can help triage early symptoms as an outpatient and may contribute to decreasing enterocolitis episodes requiring inpatient treatment.
MeSH Keywords
Hirschsprung disease; botulinum injection; Hirschsprung associated enterocolitis; pediatric surgery
Additional Files
The Power of Outpatient Botulinum Injections in Preventing Hirsch.pdf (227 kB)Abstract
Included in
The Power of Outpatient Botulinum Injections in Preventing Hirschsprung Associated Enterocolitis
Background: Hirschsprung associated enterocolitis (HAEC) is a potentially life-threatening complication, where the child often presents with obstructive symptoms. Failure of the internal anal sphincter (IAS) to relax is thought to play a role in these symptoms. Botulinum toxin (BT) injections assist in temporarily relieving obstructive symptoms due to IAS achalasia in patients with Hirschsprung’s disease following surgical pull-through. The use of BT may play a role in preventing HAEC episodes related to IAS dysfunction.
Objectives/Goal: Our aim was to determine the effect of scheduled outpatient Botulinum injections on the development of HAEC.
Methods/Design: A retrospective review between July 2010 – July 2020 of children diagnosed with Hirschsprung’s disease who had already undergone their pull-through procedure was performed. Our comprehensive colorectal center, which was formulated in July 2018 helps triage patient phone calls and provides parental education about HAEC. Demographic information, the timing from pull-through to first HAEC episode and to first BT injection was recorded for analysis. Our primary analysis was to compare the rate of enterocolitis episodes and timing between episodes in patients who did and did not receive outpatient BT injections. A p-value < 0.05 was considered significant.
Results: 80 patients were initially identified; 75% were male, 69% Caucasian, and 73% had short segment disease. 45% of patients underwent a Swenson procedure, while 39% underwent a Soave procedure for definitive pull-through. Median time to pull-through was 150 days (IQR 16, 132). Eight patients were excluded from further study as no episode of HAEC or use of BT injections occurred during the study period. 46 of the 72 remaining patients (64%) developed at least one episode of enterocolitis, while 64 patients (89%) had at least one outpatient BT injection for early obstructive symptoms. The median time to first enterocolitis episode following pull-through was 71 days (IQR 16, 443), while the median time from pullthrough to BT injection was 486 days (IQR 91, 1325). Sub-analysis was performed based on the timing of the enterocolitis episode with the performance of BT injections. Nine patients required inpatient admission for enterocolitis and have never received outpatient BT injections, 35 patients developed at least one episode of enterocolitis requiring inpatient admission prior to receiving BT injection, and 28 patients underwent BT injections prior to any episodes of enterocolitis. Significantly fewer patients who received BT first developed enterocolitis (p
Conclusions: The use of outpatient BT injections decreases episodes of Hirschsprung associated enterocolitis and increases the interval between recurrent episodes. The development of a multidisciplinary colorectal center that provides parental education and frequent contact with families can help triage early symptoms as an outpatient and may contribute to decreasing enterocolitis episodes requiring inpatient treatment.
