Although extremely uncommon, severe sepsis does occur post-treatment for haemorrhoids and all surgeons who treat such patients should be aware of the potential complications and alert to their presenting features. Early presentation without evidence of tissue necrosis may be managed conservatively, although most cases are managed by means of surgery.

Histological assessment of completeness of excision of rectal adenoma and size of adenoma are important predictors of early recurrence and have potential to guide follow-up strategies after TEM.

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Fournier's gangrene has been described after injection sclerotherapy and banding of haemorrhoids as well as after conventional haemorrhoidectomy. In addition, there have been several cases following stapled haemorrhoidopexy. A patient with this complication nearly always presents within the first week following surgery. We present an illustrative case of a patient who underwent stapled haemorrhoidopexy for prolapsed haemorrhoids and presented with fever, urinary retention and peri-anal pain 39 days later. At re-operation, there was extensive peri-anal necrosis. After wide excision and fashioning of a colostomy, the patient recovered. Our case shows that late presentation can occur.

No abstract