title: Uncontrollable intra-abdominal bleeding necessitating low anterior resection of the rectum after stapled hemorrhoidopexy: report of a case.
abstract: Stapled hemorrhoidopexy (SH) has become a widely accepted surgical procedure for hemorrhoids; however, one of the most serious complications of this technique is severe bleeding. We report a case of extensive hemoperitoneum after SH for third-degree hemorrhoids. On postoperative day (POD) 1, the patient complained of severe abdominal pain and clinical signs of peritonitis soon became evident. Computed tomography (CT) showed blood in the abdomen. We performed an emergency exploratory laparotomy, which revealed extensive hemoperitoneum, and a devitalized, edematous rectum with a tense hematoma, approximately 1 cm above the staple line and extending up to the level of the peritoneal reflection. We also found a small seromuscular laceration in the anterior aspect of the rectum just above the peritoneal reflection. This small laceration was bleeding actively. Thus, we performed a low anterior resection and the patient was discharged from hospital 10 days later. We report this case to raise awareness of the possibility of life-threatening intra-abdominal complications without evidence of typical rectal bleeding.
authors.affiliation: Second Surgical Department, General Hospital of Drama, Terma Hippokratus, 66100, Drama, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Blouhos
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Vasiliadis
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Tsalis
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Botsios
authors.forename: Xenos
authors.initials: X
authors.lastname: Vrakas
mesh_terms: D000328:Adult; D003082:Colectomy; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery*; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D008297:Male; D017792:Surgical Stapling / Q000009:adverse effects*