Elsevier

Clinical Imaging

Volume 60, Issue 2, April 2020, Pages 216-221
Clinical Imaging

Body Imaging
Post hemorrhoidectomy complications: CT imaging findings

https://doi.org/10.1016/j.clinimag.2019.12.015Get rights and content

Highlights

  • Data on the radiologic findings of post hemorrhoidectomy complications is limited.

  • Complications include rectal submucosal edema, proctitis and rectal perforation.

  • Patients may even require urgent surgery and intensive care hospitalization.

  • Although uncommon, these complications carry a risk for significant consequences.

Abstract

Introduction

We aimed to describe computed tomography (CT) findings of early complications after interventional hemorrhoid treatments in emergency department (ED) patients.

Materials and methods

We identified all ED patients requiring abdominal and/or pelvic CT between February 2012 and February 2019, and included only patients who underwent CT for suspected early (up to 30 days) post hemorrhoidectomy procedure complications. Presenting symptoms, salient CT findings and clinical outcomes were collected.

Results

Overall, 48,425 abdominal and/or pelvic CTs were performed. Of these, we identified 12 patients (8 male, 4 female) who underwent CT in our ED following hemorrhoidectomy procedures. At presentation, peri-anal or abdominal pain was the most common symptom. One patient presented with hemodynamic instability.

CT findings included proctitis (4/12), rectal perforation (2/12), peri-anal abscess (1/12) and peri-anal fistula (1/12). Two of the patients with proctitis presented with significant submucosal edema.

On follow-up, three patients required intensive care hospitalization, and two of those underwent emergent laparotomy. The third patient died due to secondary infection during his hospitalization.

Conclusion

Hemorrhoidectomy procedures may result in severe complications which should be recognized by ED radiologists. These complications carry a potential risk for significant clinical consequences. Both clinicians and radiologists should be aware of the possibility of such complications when patients present to the ED early after hemorrhoid procedures.

Introduction

Hemorrhoids are a common anorectal condition, affecting 4.4% - 39% of the adult population in developed countries [[1], [2], [3]].

Multiple treatment options are available. These include non-invasive methods, such as dietary and lifestyle modifications, topical and systemic medications. When these fail, invasive outpatient procedures are sometimes required, including rubber band ligation (RBL), sclerotherapy, hemorrhoidal artery ligation and laser procedures. In more severe cases, surgical interventions including stapled hemorrhoidopexy, open hemorrhoidectomy and closed hemorrhoidectomy may be used [[4], [5], [6], [7]].

Post-procedural complications are usually mild and non life-threatning. These complications include local pain, urinary retention, mild bleeding and perianal abscess, with varying incidence, depending on the specific technique used. Life-threatening complications such as rectal perforation, sepsis, excessive bleeding, retroperitoneal and pelvic abscesses are rare [[8], [9], [10], [11], [12], [13], [14]].

To the best of our knowledge, computed tomography (CT) findings of severe post hemorrhoidectomy complications have only been rarely described [[15], [16]].

We aimed to present the CT findings of complications after various interventional treatments of hemorrhoids, in patients requiring imaging in the emergency department (ED).

Section snippets

Materials and methods

This institutional review board approved retrospective study was performed in a major tertiary teaching hospital, and included all patients presenting to the ED between February 2012 and February 2019. Informed consent was waived. We have conducted a search for all patients presenting with any clinical complaints after hemorrhoid treatment who underwent abdominal and/or pelvic CT scans in the ED. We searched radiology reports in our radiology information system for the following terms:

Results

Between February 2012 and February 2019 there were 48,425 abdominal and/or pelvic CT scans performed in our ED. Of these, 13 patients were referred to CT (5 abdominal-pelvis, 8 pelvis) with the clinical question including post hemorrhoidectomy procedure complications. One patient was excluded as his CT was performed >30 days after the hemorrhoidectomy procedure. Therefore, our final cohort included 12 patients (8 males and 4 females); with a mean age at the time of the procedure was

Discussion

Our study aimed to describe the radiological findings of early complications following hemorrhoidectomy procedures. Only a few case reports in non-radiology literature presented the CT findings of severe post hemorrhoidectomy procedure complications, mainly in the surgical literature [[15], [16]].

Hemorrhoidectomy is a common procedure, mostly performed in an outpatient setting. These procedures are generally considered safe, and the most prevalent post-procedural complications of non-surgical

Declaration of competing interest

None.

References (20)

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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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