title: Mucocele complicating stapled hemorrhoidopexy.
abstract: BACKGROUND
  Stapled hemorrhoidopexy is a safe and effective treatment for circumferential hemorrhoidal prolapse. The overall rate of complications ranges from 12,7% to 36,4% and the surgeon should be aware about their early identification and adequate treatment.
  
  
  METHODS
  Female patient, 57 years was treated with stapled hemorrhoidopexy. Two years after surgery she reported to our center the occurrence of perineal discomfort, anal spasm and tenesmus. The anal exploration showed a bulge of the right lateral wall of the rectum at the level of stapled line without any related pain. 3D 360° transanal ultrasound showed a pararectal fluid collection. A surgical operation was performed and a great amount of mucus was drained. After one year the patient is completely asymptomatic with normal defecation.
  
  
  CONCLUSIONS
  Mucocele is a rare complication which usually occurs after months from the operation and it is considered a variant of rectal pocket and it is usually completely separated from the rectal lumen at the level of stapled line. The differential diagnosis between mucocele and pararectal lesions, especially abscess may be often difficult. Surgery is the treatment of choice with a transanal approach that is generally preferred to the trans-perineal.
  
  
  CONCLUSIONS
  Mucocele is a rare complication of stapled hemorrhoidopexy that may remain asymptomatic for a long period. In case of perineal discomfort after stapled procedure the physical examination combined with 3D 360° transanal ultrasound is necessary to reach the diagnosis. The knowledge of the possible rare complications is at the base of a correct treatment.
authors.affiliation: General, Emergency and Mini-invasive Surgery, Careggi University Hospital, Florence, Italy.
authors.forename: Asia
authors.initials: A
authors.lastname: Grapsi
authors.affiliation: Proctological and Perineal Surgical Unit, Cisanello University Hospital, Pisa, Italy. Electronic address: alexstur@yahoo.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Sturiale
authors.affiliation: Proctological and Perineal Surgical Unit, Cisanello University Hospital, Pisa, Italy.
authors.forename: Bernardina
authors.initials: B
authors.lastname: Fabiani
authors.affiliation: Proctological and Perineal Surgical Unit, Cisanello University Hospital, Pisa, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Naldini
keywords: Case report; Complication; Henorrhoids; Mucocele; Rectal pocket; Stapled hemorroidopexy