Persistent Bleeding Following a Stapled Hemorrhoidopexy

Abstract

A stapled hemorrhoidopexy (SH) is widely used for treatment of patients with grades III and IV hemorrhoids. The SH is easy to perform, is associated with less pain and allows early return to normal activities. However, complications, whether severe or not, have been reported. Here, we present the case of a female patient with persistent bleeding after a SH. The bleeding was caused by the formation of granulation tissue at the stapler line, diagnosed with sigmoidoscopy, and successfully treated via transanal excision (TAE) under spinal anesthesia. The biopsy showed inflammatory granulation tissue. After the TAE, her symptom was completely gone.

Keywords: Hemorrhoidectomy; Inflammatory polyp; Rectal bleeding; Stapled hemorrhoidopexy.

Fig. 1. (A) Endoscopic findings of polyps after a staple hemorrhoidopexy: 8-mm-sized sessile polyps at the location of the scar from previous surgery, and (B) operative finding of the polyps: 2 friable polyps, 1 each in the 6 and 8 o'clock directions.

Fig. 2. Histological image of the resected polyps consisting of nonneoplastic crypts and abundant inflamed stroma, suggesting an inflammatory polyp (H&E, ×40).