Iatrogenic Botulism Following Botulinum Toxin Injection as an Adjunct to Abdominal Wall Reconstruction for Incisional Hernia

Open ventral hernia repair is one of the most commonly performed surgeries by general surgeons worldwide. In the case of complex incisional hernias, there are adjunct techniques that can help abdominal wall reconstruction surgery, such as type A botulinum toxin (BTA), whose injection results in muscle relaxation and growth of muscle fiber length, allowing fascial closure without the need for advanced techniques. We report a case of a male patient who underwent ultrasound-guided BTA injection in the abdominal wall and, five days later, was admitted to our emergency department with dysarthria, muscular weakness, dyspnea on small exertion, and constipation. There was a rapid worsening of respiratory failure, requiring invasive mechanical ventilation. After the exclusion of other neurological conditions, iatrogenic botulism was assumed to be the most likely cause. There are adjunct tools that allow successful abdominal wall reconstruction, such as BTA, which is relatively safe. On rare occasions, systemic absorption of BTA can lead to systemic effects, such as iatrogenic botulism, that can be extremely severe. We have not found any case reports about iatrogenic botulism related to BTA use in abdominal wall musculature. This is the first documented case of iatrogenic botulism related to BTA injection in the abdominal wall musculature. Given its severity, it is important that surgeons working with BTA are aware of these potential complications.