title: Hemorrhoids can be a source of obscure gastrointestinal bleeding that requires transfusion: report of five patients.
abstract: OBJECTIVE
  Hemorrhoids have been rarely reported to be a source of transfusion-dependent, obscure gastrointestinal bleeding. We report the diagnosis and management of a series of patients in whom hemorrhoids were the source of obscure gastrointestinal bleeding that was severe enough to require transfusion.
  
  
  METHODS
  Five patients, who presented with severe hematochezia or obscure gastrointestinal bleeding, during a 24-month period had had an extensive workup for gastrointestinal bleeding. All had required transfusion of 2 units or more of blood. In the absence of other causes of bleeding, the five patients had unprepared flexible sigmoidoscopy on the same day that they reported hematochezia to exclude a proximal source of bleeding. All were found to have internal hemorrhoids as a likely source of bleeding, which was confirmed at exploration under anesthesia, and were treated by surgical hemorrhoidectomy.
  
  
  RESULTS
  The five patients underwent surgical, Ferguson-type, hemorrhoidectomy. One patient required 1 unit of blood immediately postoperatively, but none have required further transfusion or reported hematochezia in more than three months of follow-up.
  
  
  CONCLUSIONS
  We have shown that hemorrhoids can be a source of transfusion-dependent, obscure gastrointestinal bleeding. This aspect of the common problem of hemorrhoidal bleeding has not been previously reported, which reflects underreporting or missed diagnosis.
authors.affiliation: Department of Medicine, Caritas St. Elizabeth's Medical Center, Brighton, Massachusetts, USA.
authors.forename: Ahmer M
authors.initials: AM
authors.lastname: Ibrahim
authors.forename: Alan W
authors.initials: AW
authors.lastname: Hackford
authors.forename: Young-Mee
authors.initials: YM
authors.lastname: Lee
authors.forename: David R
authors.initials: DR
authors.lastname: Cave
mesh_terms: D000328:Adult; D000368:Aged; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000601:surgery; D006484:Hemorrhoids / Q000150:complications* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged