Abstract | PURPOSE: To assess the efficacy of Botulinum toxin A ( BoNT-A) in the treatment of patients with hypercontractile stomas resulting in repeated pouching system failures and leaks. DESIGN: Prospective case series. SUBJECTS AND SETTING: Ten consecutive patients who presented to the outpatient stoma clinic with actively contractile stomas that shortened spasmodically resulting in leaks were offered treatment with BoNT-A if treatment with other measures had been unsuccessful. METHODS: Following an observed reduction in the peristalsic shortening of a stoma after intradermal injection of BoNT-A for hyperhidrosis, we conducted a prospective case series of 10 patients with pouch adhesive failures attributed to spasmodic shortening of the stoma. Ten patients, 3 with urostomies and 7 with ileostomies, were offered BoNT-A injection. The first was treated cautiously with 15 units of BoNT-A injected into the muscularis layer, followed by an additional 25 units injected 1 month later. Subsequent patients received doses varying from 50 to 100 units. Ongoing treatments ranged 50 to 100 units every 3 to 6 months. RESULTS: Seventy percent (n = 7) of patients reported a useful reduction in leakage and pouching system seal failures. In these 7 patients, the frequency of pouch changes changed from an average of 2.18 to 0.44 per day (over all 10 patients this was a change from an average of 2.35 per day to 1.16 per day). No adverse side effects were reported. CONCLUSION: Findings from this clinical case series suggest that BoNT-A may be a promising treatment in the management of patients with leaks caused by actively contracting stomas.
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Authors | Vanessa M Smith, Calum C Lyon |
Journal | Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society
(J Wound Ostomy Continence Nurs)
2015 Jan-Feb
Vol. 42
Issue 1
Pg. 83-8
ISSN: 1528-3976 [Electronic] United States |
PMID | 25549312
(Publication Type: Journal Article)
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Chemical References |
- Neuromuscular Agents
- Botulinum Toxins, Type A
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Topics |
- Botulinum Toxins, Type A
(adverse effects, drug effects, therapeutic use)
- Humans
- Ileostomy
(nursing)
- Injections, Intradermal
- Neuromuscular Agents
(pharmacology, therapeutic use)
- Surgical Stomas
(adverse effects)
- Treatment Outcome
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