Outcome of delayed hemorrhage following surgical hemorrhoidectomy

Abstract

Delayed hemorrhage following surgical hemorrhoidectomy is a well-recognized complication. Emergency treatment may include suture ligation, anal packing, or other means of tamponade. At the Lehigh Valley Hospital, 27 patients were seen with the complication of delayed hemorrhage over an eight-year period from 1983 to 1990, for an incidence of 0.8 percent. Twenty-five patients (93 percent) underwent surgery primarily for hemorrhoidal disease; one patient had hemorrhoids removed in addition to a sphincterotomy for anal tissue, and the remaining patient had hemorrhoidectomy with fistulotomy. The mean interval from the operation to hemorrhage was six days. Treatment modalities included bedside anal packing in 20 patients (74 percent), observation alone in five patients (18 percent), and suture ligation in the operating room in two patients. Anal packing was successful in controlling postoperative hemorrhage in 20/20 patients, but late complications requiring reoperation developed in 15 percent.

Effective Management of Posthemorrhoidectomy Secondary Hemorrhage Using Rectal Irrigation

“…Posthemorrhoidectomy secondary (referred to as late or delayed) hemorrhage occurs from several days to three weeks after surgery. 9,11,14 The reported rate ranges widely from 0.6 to 5.4 percent, 1-7 which correlates with the rate (0.9 percent) in this study. The treatment of PHSH remains controversial.…”

“…[9][10][11] Rosen et al 11 suggested a rigid sigmoidoscopic examination to remove all blood and clots, followed by anal packing of Gelfoam ® wrapped by a topical hemostat to stop bleeding, 7 (35 percent) patients having complications and 15 percent of patients requiring a reoperation. Basso 15 claimed that all patients treated using tamponade with an inflated Foley catheter stopped bleeding instantaneously, and no secondary hemorrhage was inflicted by this procedure.…”

“…In 1922 Burrows and Burrows 8 first described using a rectal packing to stop the bleeding. Since then, other rectal compression devices, such as a rectal pack, 9 plug, 10 or Gelfoam ® (Pharmacia & Upjohn, Kalamazoo, MI), 11 have also been advocated. These obstructing devices are painful, and an extended hospital stay is necessary for closer observation.…”

Outpatient haemorrhoidectomy in a colorectal surgical unit

“…Bleeding was the most important with an incidence of 1.3%. Similar values are reported in the literature, with a range between 0.5 to 2.0% [8]. Although the spectrum of bleeding reported in the literature ranges from mild to severe life threatening bleeding requiring transfusions, all of our cases were promptly resolved only with ligation of the vascular pedicle, and none of our patients required a blood transfusion.…”

Konsensusbericht Hämorrhoidalleiden

“…Tag mit einer Häufi gkeit von 0.8 %-2.5 % auf, besonders gefährdet sind Patienten, die unter Antikoagulantientherapie stehen [97,98]. Eine Injektion mit Adrenalin und/oder eine lokale Kompressionsbehandlung mit Gaze oder Ballonkatheter kann erfolgreich sein.…”