Intra-abdominal rectal perforation post-haemorrhoidal artery ligation operation and converted Ligasure open haemorrhoidectomy

Abstract

We report an unfortunate case of rectal perforation and subsequent peritonitis in a 74-year-old lady who underwent haemorrhoidal artery ligation in order to treat complex large external and internal haemorrhoids. Serious complications following haemorrhoid surgery are rare and this is the first documented case of delayed intra-abdominal rectal perforation following a haemorrhoid artery ligation operation and converted Ligasure open haemorrhoidectomy.

Pneumoperitoneum, retropneumoperitoneum and pneumomediastinum after stapled hemorrhoidopexy

“…Among the early complications are bleeding (most common), pain, fecal urgency, rectal stenosis, submucosal hematoma, early Pneumoperitoneum, retropneumoperitoneum and pneumomediastinum after stapled Brazilian Journal of Case Reports. 2022; 02(4):33-40 thrombosis of external hemorrhoids, in addition to specific complications of stapled hemorrhoidopexy, such as failures in the stapling weapon, urosepsis, pelvic sepsis, rectal perforation, sepsis with retropneumoperitoneum and pneumomediastinum [1,4].…”

“…The most common late complications again include bleeding, in addition to incontinence and fecal urgency and/or flatus, painful evacuation, tenesmus, anal itching, anal fissure, anal stenosis, anastomotic cysts and intramural fistulization [1,4]. A lower rate of complications was associated with stapled hemorrhoidopexy compared to other methods, except tenesmus, which is more commonly reported in PPH [4].…”

“…Hemorrhoids are defined as an increase in anal vascular cushions that often cause discomfort, itching, pain and bleeding, especially during defecation [1,2]. It is a disease with a prevalence rate of 4% to 34% [2,3], being more common in individuals aged 45 to 65 years [1].…”

“…Hemorrhoids are defined as an increase in anal vascular cushions that often cause discomfort, itching, pain and bleeding, especially during defecation [1,2]. It is a disease with a prevalence rate of 4% to 34% [2,3], being more common in individuals aged 45 to 65 years [1]. Its main etiology is believed to There are several surgical techniques for the treatment of hemorrhoidal disease, the most used currently being stapled hemorrhoidopexy.…”

“…Treatment can range from a conservative or even surgical approach, depending on the severity and degree of prolapse. Surgery is indicated in grade III and grade IV hemorrhoids and occurs in 10 to 20% of symptomatic patients [1,3]. There are several surgical techniques for the treatment of hemorrhoidal disease, such as hemorrhoidectomy (using the technique of Milligan & Morgan, Ferguson, Parks, among others) and, the most used currently, mechanical hemorrhoidopexy with a circular stapler, described by Longo [1,[3][4][5][6].…”