TREATMENT OF HEMORRHOIDAL PROLAPSE WITH MYIASIS AT A REGIONAL HOSPITAL IN THE FEDERAL DISTRICT - CASE REPORT

Case Presentation A 53-year-old male patient, with no known comorbidities, in a vulnerable social situation, was admitted to a regional public hospital in the Federal District with complaints of bleeding, prolapsed hemorrhoids associated with hemorrhoidal myiasis. On physical examination, grade IV hemorrhoidal nodules were present at 11 o'clock and 7 o'clock, with metaplasia in the distal third, active bleeding, and local myiasis. Antibiotic therapy was initiated, and an ivermectin dose was administered. A colonoscopy was performed, revealing a normal endoscopic examination. A biopsy was performed, showing moderate proctitis in the anal canal/distal rectum with reactive atypia, without evidence of high-grade dysplasia or invasive features. The patient underwent a Milligan-Morgan hemorrhoidectomy on the hemorrhoidal nodules. He had a good recovery and was discharged with support from the social service for outpatient follow-up. Upon return evaluation, he presented with residual plicae and no fistulas on examination, with no complaints or complications.

Discussion Hemorrhoidal disease is common and affects millions of people worldwide, representing a challenge due to the uncomfortable symptoms and impact on quality of life. It is characterized by the enlargement and displacement of the anal cushions. The most common symptom is bleeding, and chronic increases in the effort during bowel movements can lead to prolapse. Physical examination is crucial for identifying hemorrhoids, and for patients with suspected hemorrhoidal bleeding, endoscopic evaluation may be necessary. Conservative treatment involves lifestyle changes, while instrumental and surgical treatments are reserved for severe cases. Myiasis is a parasitic disease caused by the infestation of tissue by fly larvae. It can be classified as external (cutaneous) or internal (intestinal and cavity forms) and is directly associated with low socioeconomic status.

Conclusion The presence of myiasis associated with hemorrhoidal prolapse may be corroborated by the socioeconomic context present in this case. Clinical treatment, along with surgical intervention, minimized the risk of other complications and improved the patient's quality of life.

Publication History

Article published online:
25 April 2025