RECTAL OBSTRUCTION DUE TO A HUGE SUBMUCOUS HEMATOMA AFTER PROCEDURE FOR PROLAPSED HEMORRHOIDS (PPH) -REPORT OF A CASE-

Abstract

We report a case of rectal obstruction due to a huge submucosal hematoma formed after PPH stapled hemorroidectomy. The patient was a 69-year-old woman suffering from prolapse of pile for a month, which was diagnosed as third-degree hemorrhoids according to the Goligher classification. PPH was performed under spinal anesthesia. At surgery, and anal dilator was inserted into the anus, pursestring sutures were made for the entire circumference of the rectum by rotating a purse-string anoscope. When the sutures were pulled, she complained of crampy abdominal pain and nausea with a decrease of blood pressure and bradycardia. Four days after the operation, no defecation occurred, a soft mass was palpated in the lower rectum, and she felt severe pain around the anastomosis. Pelvic CT scan conducted on the postoperative day 7 showed a mass 7cm in diameter of the rectum, which was thought to be a submucous hematoma.
PPH is thought to be a useful treatment with advantages in terms of less postoperative pain, safety, and early return to work. However, we must confirm that an easy use of PPH for hemorrhoidal diseases can be associated with complications and pursue to study more appropriate candidates and precise technique.