Management of Recurrent Enterocolitis Following Soave’s Pull-Through in a Child With Hirschsprung’s Disease: Value of Botox Injections

Abstract

Recurrent enterocolitis (RE) is a common problem following Soave's pull-through for Hirschsprung's disease. The main cause of this is outlet obstruction. This can be anatomical (stricture, stenosis, and twist of bowel) or histological (aganglionic or transition zone pull through). Outlet obstruction leading to RE can be from two factors that are specific to Soave's pull through: hypertonicity of the internal anal sphincter or residual cuff. A residual cuff can be managed through excision of the cuff, although this is a major surgical undertaking. We report a successful use of Botox in a child with RE secondary to residual cuff following primary laparoscopic Soave's operation. A Botox injection was administered under general anesthesia at five separate sittings. This case demonstrates that repeated Botox injections can be a valuable alternative to colostomy, excision of residual cuff or a redo pull-through when a cuff is thought to be responsible for RE.