title: A novel use for botulinum toxin A in the management of ileostomy and urostomy leaks.
abstract: OBJECTIVE
  To assess the efficacy of Botulinum toxin A (BoNT-A) in the treatment of patients with hypercontractile stomas resulting in repeated pouching system failures and leaks.
  
  
  METHODS
  Prospective case series.
  
  
  METHODS
  Ten consecutive patients who presented to the outpatient stoma clinic with actively contractile stomas that shortened spasmodically resulting in leaks were offered treatment with BoNT-A if treatment with other measures had been unsuccessful.
  
  
  METHODS
  Following an observed reduction in the peristalsic shortening of a stoma after intradermal injection of BoNT-A for hyperhidrosis, we conducted a prospective case series of 10 patients with pouch adhesive failures attributed to spasmodic shortening of the stoma. Ten patients, 3 with urostomies and 7 with ileostomies, were offered BoNT-A injection. The first was treated cautiously with 15 units of BoNT-A injected into the muscularis layer, followed by an additional 25 units injected 1 month later. Subsequent patients received doses varying from 50 to 100 units. Ongoing treatments ranged 50 to 100 units every 3 to 6 months.
  
  
  RESULTS
  Seventy percent (n = 7) of patients reported a useful reduction in leakage and pouching system seal failures. In these 7 patients, the frequency of pouch changes changed from an average of 2.18 to 0.44 per day (over all 10 patients this was a change from an average of 2.35 per day to 1.16 per day). No adverse side effects were reported.
  
  
  CONCLUSIONS
  Findings from this clinical case series suggest that BoNT-A may be a promising treatment in the management of patients with leaks caused by actively contracting stomas.
authors.affiliation: Vanessa M. Smith, MRCP, Dermatology Registrar, York Teaching Hospital NHS Foundation Trust, Dermatology Department, York Hospital, Wigginton Road, York, the United Kingdom. Calum C. Lyon, MA, FRCP, Consultant Dermatologist, York Teaching Hospitals Foundation Trust, Dermatology Department, York Hospital, York, the United Kingdom; and Hope Hospital, Salford, the United Kingdom.
authors.forename: Vanessa M
authors.initials: VM
authors.lastname: Smith
authors.forename: Calum C
authors.initials: CC
authors.lastname: Lyon
mesh_terms: D019274:Botulinum Toxins, Type A / Q000009:adverse effects / Q000187:drug effects* / Q000627:therapeutic use*; D006801:Humans; D007081:Ileostomy / Q000451:nursing*; D007271:Injections, Intradermal; D009465:Neuromuscular Agents / Q000494:pharmacology / Q000627:therapeutic use*; D054047:Surgical Stomas / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A