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Case Reports
. 2022 Jul 6;10(19):6656-6663.
doi: 10.12998/wjcc.v10.i19.6656.

Massive gastrointestinal bleeding after endoscopic rubber band ligation of internal hemorrhoids: A case report

Yu-Dong Jiang  1 , Ying Liu  1 , Jian-Di Wu  1 , Gang-Ping Li  1 , Jun Liu  1 , Xiao-Hua Hou  1 , Jun Song  2
Affiliations
Case Reports

Massive gastrointestinal bleeding after endoscopic rubber band ligation of internal hemorrhoids: A case report

Yu-Dong Jiang et al. World J Clin Cases. .

Abstract

Background: Rubber band ligation (RBL) using rigid anoscope is a commonly recommended therapy for grade I-III symptomatic internal hemorrhoids. Severe complications of RBL include pain, hemorrhage and sepsis. Flexible endoscopic RBL (ERBL) is now more commonly used in RBL therapy but few severe complications have been reported. Here we report on a case of massive bleeding after ERBL.

Case summary: A 31-year-old female was admitted to the department of gastroenterology with a chief complaint of discontinuous hematochezia for 2 years. No previous history, accompanying diseases or drug use was reported. Physical examination and colonoscopy showed grade II internal hemorrhoids. The patient received ERBL therapy. Five days after ligation, the patient presented with mild hematochezia. On days 7 and 9 after ligation, she presented with a large amount of rectal bleeding, dizziness and weakness. Emergency colonoscopy revealed active bleeding and an ulcer in the anal wound. The patient received two sessions of hemoclipping on days 7 and 9 to treat the bleeding. No further bleeding was reported up to day 15 and she was discharged home. Although the hemorrhoid prolapse disappeared after ERBL, she was dissatisfied with the subsequent complications.

Conclusion: ERBL therapy is an effective treatment for symptomatic internal hemorrhoids with satisfactory short and long-term recovery. Pain and anal bleeding are the most frequently reported postoperative complications. Coagulation disorders complicate the increased risk of bleeding. Although rarely reported, our case reminds us that those patients without coagulation disorders are also at risk of massive life-threatening bleeding and need strict follow-up after ligation.

Keywords: Bleeding; Case report; Complication; Endoscopy; Internal hemorrhoids; Rubber band ligation.

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Conflict of interest statement

Conflict-of-interest statement: All authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Endoscopic images of endoscopic rubber band ligation therapy. A: Prolapsed hemorrhoids in forward view before endoscopic rubber band ligation (ERBL); B: Retroflexion view of hemorrhoids before ERBL; C: Ligation of hemorrhoids during ERBL; D: the prolapsed hemorrhoid tissue was withdrawn into the anus after ERBL.
Figure 2
Figure 2
Endoscopic images during follow-up study. A: Active oozing of blood on 7 d post-endoscopic rubber band ligation (ERBL); B: Ulcer and active bleeding on 9 d post-ERBL; C: image after endoscopic hemostasis using clips; D: 12 d post-ERBL; E: 15 d post-ERBL; F: 3 mo post-ERBL.
Figure 3
Figure 3
Curve of hemoglobin before and after endoscopic rubber band ligation therapy.
See this image and copyright information in PMC

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