Edematous and painful external hemorrhoids following intersphincteric resection for low rectal cancer.
Intersphincteric resection (ISR) is the ultimate sphincter saving procedure for low rectal cancer. Hemorrhoids are a common benign condition. We present and discuss a case of ISR which developed painful edematous hemorrhoids after ISR. A 62-year-old female with low rectal cancer received neoadjuvant chemoradiotherapy with successful down staging of tumor before undergoing robot assisted ISR with coloanal hand-sewn anastomosis. She had pre-existing external hemorrhoids which were not excised. She developed painful and edematous external hemorrhoids 4 days after surgery. These were treated conservatively before discharge. Many colorectal surgeons performing ISR have experienced similar situations in their patients, but none have reported on this phenomenon. We discuss the possible factors that may contribute to this situation. A possible solution is prophylactic excision of the hemorrhoids during coloanal anastomosis. Painful hemorrhoids may occur after ISR and if managed conservatively, the outcome is skin tags.
Division of Colorectal Surgery, Department of Surgery, Korea University Anam Hospital, Seoul, Korea.
Quor Meng
QM
Leong
Dong-Nyoung
DN
Son
Se-Jin
SJ
Baek
Jae-Sung
JS
Cho
Azali
A
Amar
Jung-Myun
JM
Kwak
Seon-Hahn
SH
Kim