Body ImagingPost hemorrhoidectomy complications: CT imaging findings☆
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)
- et al.
The prevalence of hemorrhoids and chronic constipation
Gastroenterology.
(1990) - et al.
Haemorrhoidal artery ligation versus rubber band ligation for the management of symptomatic second-degree and third-degree haemorrhoids (HubBLe): a multicentre, open-label, randomised controlled trial
Lancet.
(2016) Life threatening sepsis and mortality following stapled hemorrhoidopexy
Surgery
(2008)- et al.
Factors associated with hemorrhoids in Korean adults: Korean national health and nutrition examination survey
Korean J Fam Med
(2014) - et al.
The prevalence of hemorrhoids in adults
Int J Colorectal Dis
(2011) Treatment of hemorrhoids: a coloproctologist’s view
World J Gastroenterol
(2015)- et al.
Towards a core outcome set for hemorrhoidal disease-a systematic review of outcomes reported in literature
Int J Colorectal Dis
(2018) - et al.
The hemorrhoid laser procedure technique vs rubber band ligation: a randomized trial comparing 2 mini-invasive treatments for second- and third-degree hemorrhoids
Dis Colon Rectum
(2011) Hemorrhoids: from basic pathophysiology to clinical management
World J Gastroenterol
(2012)Rubber band ligation of hemorrhoids: a guide for complications
World J Gastrointest Surg
(2016)
Cited by (4)
Aṣṭāṅgahṛdaya: A Scientific Synopsis of the Classic Ayurveda Text
2023, Coresource 2Intra-abdominal rectal perforation post-haemorrhoidal artery ligation operation and converted Ligasure open haemorrhoidectomy
2021, Journal of Surgical Case Reports
- ☆
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.