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.
