Perirectal hematoma after stapled surgery for hemorrhoidal prolapse and obstructed defecation syndrome: case series management to avoid panic-guided treatment

Updates in Surgery · 9 authors, 6 centres

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TL;DR

Management included intravenous fluids, antibiotics, and imaging (pelvic CT in all cases).

Full summary

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Management included intravenous fluids, antibiotics, and imaging (pelvic CT in all cases). Four patients required blood transfusions, and two required embolization for active bleeding. Eight cases underwent anorectal examination under anesthesia, leading to surgical drainage or hemostasis in some. Transanal spontaneous drainage occurred in nine cases. No patients required abdominal surgery, and all were reported as clinically well at one-year follow-up. The study suggests a treatment algorithm prioritizing medical management and minimally invasive procedures over aggressive surgery, which is often panic-guided.

STUDY TYPE

case_report

SPECIALTY

surgery

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100% · A

ORIGINAL PAPER

PMC10042767

Perirectal hematoma after stapled surgery for hemorrhoidal prolapse and obstructed defecation syndrome: case series management to avoid panic-guided treatment

Updates in Surgery

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ABSTRACT

Abstract Perirectal hematoma (PH) is one of the most feared complications of stapling procedures. Literature reviews have reported only a few works on PH, most of them describing isolated treatment approaches and severe outcomes. The aim of this study was to analyze a homogenous case series of PH and to define a treatment algorithm for huge postoperative PHs. A retrospective analysis of a prospective database of three high-volume proctology units was performed between 2008 and 2018, and all PH cases were analyzed. In all, 3058 patients underwent stapling procedures for hemorrhoidal disease or obstructed defecation syndrome with internal prolapse. Among these, 14 (0.46%) large PH cases were reported, and 12 of these hematomas were stable and treated conservatively (antibiotics and CT/laboratory test monitoring); most of them were resolved with spontaneous drainage. Two patients with progressive PH (signs of active bleeding and peritonism) were submitted to CT and arteriography to evaluate the source of bleeding, which was subsequently closed by embolization. This approach helped ensure that no patients with PH were referred for major abdominal surgery. Most PH cases are stable and treatable with a conservative approach, evolving with self-drainage. Progressive hematomas are rare and should undergo angiography with embolization to minimize the possibility of major surgery and severe complications. Keywords: Perirectal hematoma, Stapler, Hemorrhoids, Complications

CITATION EXPORT

Domenico Mascagni, Chiara Eberspacher, Gabriele Naldini et al.. Perirectal hematoma after stapled surgery for hemorrhoidal prolapse and obstructed defecation syndrome: case series management to avoid panic-guided treatment. Updates in Surgery. (2023). https://doi.org/10.1007/s13304-023-01490-y

AUTHORS

9 · 6 CENTRES

Domenico Mascagni, Chiara Eberspacher, Gabriele Naldini, Francesco Leone Arcieri, Pietro Mascagni, Roberto Cirocchi, Georgi Popivanov, Pierpaolo Sileri, Stefano Arcieri

1Department of Surgery, University of Rome “Sapienza”, Viale Regina Elena 324, 00100 Rome, Italy
2Proctology and Pelvic Floor Clinical Centre, Cisanello University Hospital, Pisa, Italy
3Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
4Department of General Surgery, University of Perugia, 06100 Perugia, Italy
5Department of Surgery, Military Medical Academy, 1606 Sofia, Bulgaria
6University Vita-Salute San Raffaele, Milan, Italy