Major Pelvic Bleeding Following a Stapled Transanal Rectal Resection: Use of Laparoscopy as a Diagnostic Tool

Abstract

Stapled transanal rectal resection (STARR) and stapled hemorrhoidopexy (SH) are well-established techniques for treating rectal prolapse and obstructed defecation syndrome (ODS). Occasionally, they can be associated with severe complications. We describe the case of a 59-year-old woman who underwent STARR for ODS and developed a postoperative pelvic hemorrhage. A computed tomography (CT) scan revealed a vast pelvic, retroperitoneal hematoma and free gas in the abdomen. Laparoscopy ruled out any bowel lesions, but identified a hematoma of the pelvis. Flexible sigmoidoscopy showed a small leakage of the rectal suture. The patient was treated conservatively and recovered completely. Surgeons performing STARR and SH must be aware of the risk of this rare, but severe, complication. If the patient is not progressing after a STARR or SH, a CT scan can be indicated to rule out intra-abdominal and pelvic hemorrhage. Laparoscopy is a diagnostic tool and should be associated with intraluminal exploration with flexible sigmoidoscopy.

Keywords: Laparoscopy; Postoperative hemorrhage; Rectal prolapse.

Fig. 1. Rectal cylinder removed by using a stapled transanal rectal resection.

Fig. 2. Computed tomography scan showing a vast pelvic, retroperitoneal hematoma with no active bleeding.

Fig. 3. Laparoscopic view of the pelvic hematoma. No intraperitoneal bleeding is seen.

Fig. 4. Endoscopic view of the suture line with a minimal partial disruption of the suture, which might have allowed a small leakage of air towards the peritoneal cavity.