Rubber band ligation was used in 221 patients with first or second-degree hemorrhoids. All three primary hemorrhoids were ligated at a single out-patient session without anesthesia. Nineteen patients were lost to follow up. For the 202 patients under review, the follow up period ranged from three to 39 months with a mean of 18.4 months and median of 17 months. Excellent or good results were obtained in 183 patients (90.6 per cent). Moderate to severe pain was noticed by 58 patients (28.7 per cent). Further banding was required in 28 patients (13.9 per cent) and hemorrhoidectomy in six patients (3 per cent). The overall complication rate resulting from the treatment procedure was 3.5 per cent.

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We discuss the first ever case of rivaroxaban causing major intra-abdominal hemorrhage found in a patient during emergency hernioplasty. The source of bleeding was not identified either intra- or postoperatively. This is on a background of treatment for deep vein thrombosis (DVT) with rivaroxaban, a complication that resulted from a total knee arthroplasty performed four weeks prior. Rivaroxaban is a new generation of anticoagulants that directly inhibits factor Xa and is used for DVT treatment in major orthopaedic surgery. Here we discuss the major side effects of rivaroxaban, namely, the increased risk of major bleeding as well as the irreversibility of this anticoagulant, should such bleeding occur. We advise caution in the use of rivaroxaban even in patients that are at low risk of bleeding given the discovery of hemorrhage as presented in this case.