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Outcome after anal intrasphincteric botox injection in children with surgically treated hirschsprung disease.
[hirschsprung disease]
A
nonrelaxing
internal
anal
sphincter
is
present
in
a
relatively
large
proportion
of
children
with
surgically
treated
Hirschsprung
disease
(
HD
)
and
can
cause
obstructive
gastrointestinal
symptoms
.
The
short
-
and
long
-term
outcome
and
adverse
effects
of
intrasphincteric
botulinum
toxin
(
Botox
)
injections
in
children
with
obstruction
after
surgically
treated
HD
are
evaluated
.
The
outcome
of
children
with
surgically
treated
HD
treated
with
intrasphincteric
Botox
injections
for
obstructive
symptoms
was
analyzed
with
a
retrospective
chart
review
between
2002
and
2013
in
the
University
Medical
Centers
of
Maastricht
and
Nijmegen
.
A
total
of
33
patients
were
included
.
The
median
time
of
follow-up
was
7
.
3
years
(
range
1
-
24
)
.
A
median
of
2
(
range
1
-
5
)
injections
were
given
.
Initial
improvement
was
achieved
in
76
%
,
with
a
median
duration
of
4
.
1
months
(
range
1
.
7
-
58
.
8
)
.
Proportion
of
children
hospitalized
for
enterocolitis
decreased
after
treatment
from
19
to
7
.
A
good
long
-term
response
was
found
in
49
%
.
Two
children
experienced
complications
:
transient
pelvic
muscle
paresis
with
impairment
of
walking
.
In
both
children
symptoms
resolved
within
4
months
without
treatment
.
Intrasphincteric
Botox
injections
in
surgically
treated
HD
are
an
effective
long
-term
therapy
in
approximately
half
of
our
patients
with
obstructive
symptoms
.
The
possibility
of
adverse
effects
should
be
noticed
.
