Selene Kizy
Pronouns:
Research Mentor(s): Kathryn Maselli
Research Mentor School/College/Department: Pediatric Surgery Section / Medicine
Program:
Authors: Selene Kizy, Kathryn Maselli, K. Elizabeth Speck
Session: Session 3: 11:00 am – 11: 50 am
Poster: 59
Abstract
Background and aim: Chronic constipation poses a significant health concern in childhood, stemming from various factors such as functional constipation (FC) and congenital disorders, such as Hirschsprung disease (HD). Anal sphincter BoTox injection has been proposed as a potential treatment of both FC and HD, but data is still limited on the benefits. The purpose of this study was to evaluate the efficacy of anal sphincter botox injection among these two groups in pediatric patients. It was also aimed to compare the outcomes of ultrasound-guided botox injections against blind injections. Methods: A retrospective chart review of patients <21 years of age who who underwent anal BoTox injections between January 2010 and December 2023 was conducted. Data collected included sex, race, diagnosis, and pre- and post-injection frequency of bowel movements, pain levels during defecation, stool consistency on the Bristol Scale, and presence and frequency of fecal incontinence. For patients with HD, the type of pull-through operation, post-operative complications, and episodes of Hirschprung associated enterocolitis (HAEC) before and after botox was also assessed. Results: A total of 66 pediatric patients were reviewed (65% male). The majority of patients were white (68.2%) and the most common diagnosis was FC (58%). 100% of injections were performed under ultrasound guidance, with no major complications. For patients with HD, 5 (18%) needed a re-do pull-through, and 75% presented HAEC post-op. The median number of injections was 2.5, with a range of 1-12. A quarter of patients needed more than 4 injections. Fifty-five percent had HAEC after the first injection. In FC patients, the median number of injections was 1 (range: 1-6). The majority received only 1 botox injection (79%), with 21% needing multiple injections. Conclusions: Ultrasound-guided BoTox injections are safe in pediatric patients. Patients with HD tended to receive more injections than those with FC, due to recurrent HAEC. Most patients with FC only got 1 injection, although it is unclear if this was due to symptomatic improvement following a single injection. Further research is planned to determine the relative efficacy of BoTox injections regarding pre- and post-op information among HD and FC patients.
