A novel technique for the treatment of post operative retro-rectal haematoma: two case reports

Abstract

Rectal bleeding following any form of rectal surgery is a well recognised complication 1, 2, 3 & 4. However retro-rectal bleeding and tracking which then presents as rectal bleeding has not been reported in the literature. We describe a novel way of dealing with this technically difficult post-operative complication.We present two cases of significant rectal bleeding (one following STARR procedure and other after Delormes procedure). Both patients had to be taken back to theatre due to continuing, significant bleeding. Examination under anaesthesia on both occasions revealed a posterior boggy swelling, with an opening which admitted a finger. In both cases clots were evacuated and a corrugated drain was inserted in to the retro rectal space.The authors believe that following any form of rectal surgery, retro-rectal bleeding with tracking can present as rectal bleeding. Treatment in the form of EUA and insertion of corrugated helped to resolve the problem.We present both cases and literature review of the complications of stapled haemorrhoidopexy.

Perirectal Hematoma and Intra-Abdominal Bleeding after Stapled Hemorrhoidopexy and STARR—A Proposal for a Decision-Making Algorithm

“…Seven studies were excluded based on reasons listed in Table 1 [12][13][14][15][16][17][18]. Cumulatively, 17 articles (15 case reports and two case series) were considered relevant, and 38 patients were included ( Figure 1, Seven papers reported perirectal hematoma [3,17,18,[20][21][22][23][24][25][26][27]. In seven articles, intraabdominal bleeding was described [28][29][30][31][32][33][34], two reported retroperitoneal hematoma [19,25].…”

“…Seven studies were excluded based on reasons listed in Table 1 [ 12 , 13 , 14 , 15 , 16 , 17 , 18 ]. Cumulatively, 17 articles (15 case reports and two case series) were considered relevant, and 38 patients were included ( Figure 1 , Table 2 ) [ 3 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ].…”

“…Seven papers reported perirectal hematoma [ 3 , 17 , 18 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. In seven articles, intraabdominal bleeding was described [ 28 , 29 , 30 , 31 , 32 , 33 , 34 ], two reported retroperitoneal hematoma [ 19 , 25 ].…”

“…The data about hemodynamic status were reported in all case reports and the case series [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ]: a hemodynamic instability was reported in a few cases (18.9%, 7/37) and a hemodynamic stabilization and resuscitation were needed.…”