Rectal perforation after procedure for prolapse and hemorrhoids: possible causes.
OBJECTIVE
Our aim was to explore possible causes of rectal perforation occurring in patients who undergo the procedure for prolapse and hemorrhoids.


METHODS
We evaluated data from cases of rectal perforation that occurred after the procedure for prolapse and hemorrhoids in China in conjunction with case reports from the international medical literature.


RESULTS
We identified 7 patients from 5 hospitals in 2 provinces of China who had rectal perforation after the procedure despite having received prophylactic antibiotic treatment. Two patients had a disrupted staple line and 5 had perforations on the rectum wall above the intact staple line. Six patients presented with symptoms in the first 3 days after the procedure. Three patients had concomitant disease: 1 had concomitant constipation and internal rectal prolapse, 1 had concomitant constipation, and 1 had concomitant liver cirrhosis ascites that was not diagnosed preoperatively. Of the 15 cases of rectal perforation found in the literature, 3 patients had an intact staple line and 5 patients had a ruptured staple line.


CONCLUSIONS
The cone-shaped tip of the anvil, concomitant rectal prolapse and pelvic floor descent, and concomitant ascites are possible causes of rectal perforation after the procedure for prolapse and hemorrhoids.
Gao
Xian Hua
XH
Department of Colorectal Surgery of Changhai Hospital, Second Military Medical University, Shanghai, China.
Wang
Han Tao
HT
Chen
Ji Gui
JG
Yang
Xiao Dong
XD
Qian
Qun
Q
Fu
Chuan Gang
CG
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006484:Hemorrhoids / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007416:Intestinal Perforation / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012005:Rectal Prolapse / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D017792:Surgical Stapling; D016896:Treatment Outcome