Treatment of Hirschsprung disease by botulinum toxin A through anorectal injection

Abstract

To investigate the feasibility and short- term effect of injecting botulinum toxin A through anorectum to treat Hirschsprung disease. Eight cases with Hirschsprung disease were proven pathologically or diagnosed by barium enema. At the clock point of 3,6,9 under supine posture,a total dose of 1.5 U/ kg of botulinum toxin A was injected into the internal anal sphincter and the submucosa of rectum. The pressure of anus- rectum was measured before operation and 1 month,1 year after operation,respectively. Barium enema examination was carried out within 3-6 months after operation,then once a year during followed- up. All of the patients recovered well without operative or postoperative complications. In the first year,all patients could defecate spontaneously without constipation and abdominal distention. Three cases had constipation again and slight abdominal distention 1 year after operation,but the symptoms were relieved after anus dilatation. The resting pressure of anus- rectum was lower 1 month after operation than that before operation (P< 0.01) in 8 cases,and still lower 1 year after operation (P< 0.05)in 6 cases. Barium enema examination within 3-6 months after operation revealed that the dilated colon shrank. Botulinum toxin A injection is a new,feasible and safe method for Hirschsprung disease,but the long- term efficacy needs to be further studied.