Endoscopic Band Ligation to Treat a Massive Hemorrhoidal Hemorrhage Following a Transrectal Ultrasound-Guided Prostate Biopsy

Abstract

Prostate cancer is commonly diagnosed by using a transrectal ultrasound (TRUS)-guided biopsy. Although this procedure is usually well tolerated, rarely it may be complicated by massive rectal bleeding. We report a case of a 77-year-old male who underwent a TRUS biopsy and subsequently developed recurrent episodes of rectal bleeding with syncope and anemia requiring the transfusion of multiple units of blood. A sigmoidoscopy revealed the source of the bleeding: a large hemorrhoid on the anterior wall of the rectum with an overlying ulceration. We successfully applied a band to ligate the hemorrhoid, and the patient's condition improved. To our knowledge, this case represents the first report of a successful band ligation to treat massive bleeding from a hemorrhoid that had been punctured in the course of the TRUS biopsy procedure.

A rare case of delayed massive rectal bleeding, after transrectal ultrasound- guided prostate biopsy, requiring a multidisciplinary approach treatment

“…Also, the rectal venous plexus in the submucosal space of this region is dense and can frequently cause bleeding. In our review of the literature, we found a case of massive rectal haemorrhage in a patient with a haemorrhoid that had been punctured in the course of TRUS-Bx [2]. In patients with haemorrhoids, the above-mentioned plexus may be substantially dilated, increasing the theoretical risk of puncture or shearing during a TRUS-Bx [3].…”

Endoscopic Therapy in the Management of Patients With Severe Rectal Bleeding Following Transrectal Ultrasound-Guided Prostate Biopsy: A Case-Based Systematic Review

“…Endoscopic band ligation is another hemostatic modality. 49 This technique particularly helps to achieve hemostasis in cases where the culprit is a submucosal visible bleeding vessel. 50 It may offer added therapeutic benefit in rectal hemorrhage due to punctured internal hemorrhoids after prostate biopsy.…”

“…Combination endoscopic therapy, consisting of varying combinations of epinephrine injection, endoclipping, and/or endoscopic band ligation, has also been used with good clinical outcomes. 8 , 48 , 49 …”

“…Combination endoscopic therapy, consisting of varying combinations of epinephrine injection, endoclipping, and/or endoscopic band ligation, has also been used with good clinical outcomes. 8,48,49 The use of endoclipping has been widely reported in gastrointestinal endoscopy. However, the placement of endoclips alone for post-biopsy rectal bleeding has rarely been described thus far.…”