Ultrasound-guided intrasphincteric botulinum toxin injection relieves obstructive defecation due to Hirschsprung's disease and internal anal sphincter achalasia.
OBJECTIVE
Chronic obstructive defecation can occur in patients with Hirschsprung Disease (HD) and internal anal sphincter (IAS) achalasia. Injection of Botulinum Toxin (BoTox) into the IAS can temporarily relieve obstructive defecation, but can be challenging when performed by tactile sense alone. We compared results of BoTox injections with and without ultrasound (US) guidance.


METHODS
We retrospectively reviewed BoTox injections into the IAS for obstructive defecation over 5years. Analyzed outcomes included short-term improvement, defined as resolution of enterocolitis, new ability to spontaneously defecate, and/or normalization of bowel movement frequency 2weeks post-operatively, as well as requirement of more definitive surgical therapy (myotomy/myomectomy, colectomy, colostomy, cecostomy/appendicostomy, and/or sacral nerve stimulator implantation). Outcomes were compared using t-test and Fisher's Exact test, with significance defined as p<0.05.


RESULTS
Twelve patients who underwent BoTox injection were included, including 5 patients who underwent injections both with and without ultrasound. Ten underwent an ultrasound-guided injection (13 injection procedures), 5 of whom had HD. Seven underwent an injection without ultrasound guidance (17 injection procedures), 5 of whom had HD. Procedures performed with US resulted in greater short-term improvement (76% versus 65% without ultrasound) and less requirement of a definitive procedure for obstructive defecation (p<0.05).


CONCLUSIONS
US-guided BoTox injection is safe and effective for obstructive defecation, and may decrease the need for a definitive operation.


METHODS
III.
Department of Surgery, Section of Pediatric Surgery, University of Michigan Health System, Ann Arbor, USA. Electronic address: jchurc@med.umich.edu.
Joseph T
JT
Church
Department of Surgery, Section of Pediatric Surgery, University of Michigan Health System, Ann Arbor, USA.
Samir K
SK
Gadepalli
Department of Surgery, Section of Pediatric Surgery, University of Michigan Health System, Ann Arbor, USA.
Toghrul
T
Talishinsky
Department of Surgery, Section of Pediatric Surgery, University of Michigan Health System, Ann Arbor, USA.
Daniel H
DH
Teitelbaum
Department of Surgery, Section of Pediatric Surgery, University of Michigan Health System, Ann Arbor, USA.
Marcus D
MD
Jarboe
D001003:Anal Canal / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001004:Anus Diseases / Q000150:complications* / Q000503:physiopathology; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003248:Constipation / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006627:Hirschsprung Disease / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D007223:Infant; D007267:Injections; D008297:Male; D009465:Neuromuscular Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D012189:Retrospective Studies; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
Botulinum toxin (BoTox); Obstructive defecation; Ultrasound