913 Role of Botulinum Toxin in the Medical Management of Respiratory Distress Secondary to Suspected Intraabdominal Hypertension After Abdominal Wall Reconstruction

Abstract Introduction Botulinum toxin (BTX) is a neurotoxin which causes functional denervation of muscles. type A has been approved for wide range clinical applications. In addition, off-label preoperative injection BTX increasingly used chemical component relaxation the lateral abdominal wall muscles prior to reconstruction. Rationale Postoperative intra-abdominal hypertension (IAH) and compartment syndrome (ACS) with consequent organ dysfunction can be potential complication after The IAH ACS practice guidelines suggest improving compliance in their medical management algorithm including neuromuscular blockade. Method Following an open retrorectus mesh repair left separation via transversus abdominis release midline incisional hernia, we report case postoperative respiratory distress acute kidney injury suspected secondary increasing intraabdominal due ileus unresponsive standard conservative measures nasogastric tube insertion, use prokinetic agents judicious fluid management. We performed Botox under ultrasound guidance musculature. This resulted improved compliance, resolution symptoms reversal renal eventual good post operative outcome. There was increase length stay by 2 days compared our average. patient remains well at 3 months operatively. Conclusions Toxin considered as adjunct if it not pre-operative setting.