Botulinum Toxin Injection For Severe Chronic Constipation in a Boy Who Had Difficulty in Defecation Management

Abstract

We report the case of a four-year-old boy who underwent botulinum toxin injection for chronic severe constipation refractory to conventional treatment. He had constipation from the age of one, which gradually worsened. Sometimes, he was able to defecated with glycerin enema, but at the age of four, he had no reaction to glycerin enema thus, he was brought to our department. Enema and oral medication were first attempted to control his defecation, but they were not effective. To remove gas and stool, a catheter was required. After obtaining informed consent, botulinum toxin was injected into the internal anal sphincter muscle under ketamine anesthesia. After the treatment, he was able to defecate in a toilet, and it became easier to induce defecation with glycerin enema. In Japan, botulinum toxin injection for chronic constipation is not covered by the government health insurance, and there are few reports on its use. In this paper, we describe its safety and effects on defecation.