PSEUDO-STRANGULATED HEMORRHOIDS AFTER LAPAROSCOPIC RECTOSIGMOIDECTOMY

Case presentation A 48-year-old male patient with mixed hemorrhoidal disease and a diagnosis of sigmoid adenocarcinoma (cT3N+M0) underwent laparoscopic rectosigmoidectomy with a mechanical end-to-end colorectal anastomosis. On the third postoperative day, he developed abdominal distension, cessation of stool and gas passage, nausea, poor dietary tolerance, and anal discomfort. Abdominal X-ray revealed small bowel distension, air-fluid levels, and a coin-stacking sign. The patient subsequently experienced pain and hematochezia, with findings of pseudo-strangulated hemorrhoids, including necrosis of one internal hemorrhoidal cushion. Open classical hemorrhoidectomy was performed on the fourth postoperative day. The patient showed progressive improvement in abdominal distension and anal pain and was discharged on the seventh postoperative day.

Discussion External and internal hemorrhoidal thrombosis are complications of hemorrhoidal disease, often triggered by factors such as evacuation trauma due to chronic constipation, opioid use, diarrhea, pregnancy, local trauma, or dietary excess. Pseudo-strangulated hemorrhoids represent the most severe form of internal hemorrhoidal thrombosis, characterized by prolapse of three hemorrhoidal cushions causing edema of external hemorrhoids or skin tags, with possible ischemia or necrosis due to sphincter compression. This condition causes intense pain, hindering defecation. Several surgical techniques employing the anal region as a rectal access route (e.g., circular stapler, TEM, TAMIS, NOSE) are increasingly utilized. While anal trauma is a potential consequence of these techniques, complications such as pseudo-strangulated hemorrhoids are rare. To date, only one case of hemorrhoidal thrombosis post-TAMIS has been reported in the literature. This case highlights the occurrence of pseudo-strangulated hemorrhoids secondary to stapling in minimally invasive surgery in a patient with pre-existing hemorrhoidal disease. The complication led to postoperative ileus, required surgical intervention, and delayed hospital discharge.

Conclusion Surgical trauma from anorectal access routes can result in hemorrhoidal thrombosis. Adequate proctological examination during the perioperative period of abdominal surgery and prompt intervention can prevent more severe complications.

 

MissingLinkText

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025