Document Type

Case Report


Higher Education | Investigative Techniques | Medicine and Health Sciences | Musculoskeletal System | Nervous System | Neurology | Other Rehabilitation and Therapy | Therapeutics


Background: A 58-year-old male with chronic bilateral treatment resistant abdominal spasms secondary complications of ascites/ alcoholic cirrhosis. Spasms would occur 4-5 times/day, lasting minutes to hours despite a 2-year course of therapeutic and pharmacological interventions. Due to treatment refraction, 6 uniformly spaced botulinum toxin type A (BTX-A) injections were placed per side, using electromyography for audible intramuscular syringe placement confirmation, while visual confirmation was made via ultrasound. During the initial trial, 6 evenly spaced injections were performed bilaterally, uniformly distributing 80U/side. Injections began bilaterally just medial to the junction of the inferior rib cage border/ anterior axillary line and progressed in a handpocket direction to the inferomedial abdomen just below the umbilicus. Subsequent dose titration followed the same injection protocol.

Methods: Per Bon Secours Mercy Health IRB policy, this case report does not qualify for Mercy Health North IRB, and a formal statement from them has been obtained.

Results: When compared to baseline, the patient’s abdominal pain and spasms reduced 33%, with a simultaneous 50% reduction total daily duration by week 1. On week 12, the patient reported exceptional functionality, sleep improvement, and no reduction of postural stability. With symptoms worsening days prior to week 12 follow up, BTX-A dosage was increased to 240U (120U each side). By week 24 follow-up, the patient has an 88% pain reduction from baseline, and eradication of spasms. During this visit, 360U (180U each side) was injected for longer therapeutic relief. The patient will now only return as needed for subsequent injections.

Conclusion: To our knowledge, this is the first case reporting the use of BTX-A injection therapy for cirrhosis induced abdominal spasms refractory to traditional interventions. BTX-A injection under electromyography and ultrasound guidance appears to be a safe and effective treatment for refractory chronic abdominal spasms.




Musculoskeletal Conditions, Neuromuscular Diseases, Pain, Posture, Spasticity, Ultrasound/Ultrasonography, Electromyography

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Figure 1.pdf (232 kB)
Right abdominal spontaneous spasm prior to first injection

Figure 2.pdf (176 kB)
In-plane US injection technique with EMG syringe

Table 1.pdf (76 kB)
Patient's post-injection symptom log



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