Massive gastrointestinal bleeding after endoscopic rubber band ligation of internal hemorrhoids: A case report

Abstract

BACKGROUND Rubber band ligation (RBL) using rigid anoscope is a commonly recommended therapy for grade I-III symptomatic internal hemorrhoids. Severe complications of RBL include pain, hemorrhage and sepsis. Flexible endoscopic RBL (ERBL) is now more commonly used in RBL therapy but few severe complications have been reported. Here we report on a case of massive bleeding after ERBL. CASE SUMMARY A 31-year-old female was admitted to the department of gastroenterology with a chief complaint of discontinuous hematochezia for 2 years. No previous history, accompanying diseases or drug use was reported. Physical examination and colonoscopy showed grade II internal hemorrhoids. The patient received ERBL therapy. Five days after ligation, the patient presented with mild hematochezia. On days 7 and 9 after ligation, she presented with a large amount of rectal bleeding, dizziness and weakness. Emergency colonoscopy revealed active bleeding and an ulcer in the anal wound. The patient received two sessions of hemoclipping on days 7 and 9 to treat the bleeding. No further bleeding was reported up to day 15 and she was discharged home. Although the hemorrhoid prolapse disappeared after ERBL, she was dissatisfied with the subsequent complications. CONCLUSION ERBL therapy is an effective treatment for symptomatic internal hemorrhoids with satisfactory short and long-term recovery. Pain and anal bleeding are the most frequently reported postoperative complications. Coagulation disorders complicate the increased risk of bleeding. Although rarely reported, our case reminds us that those patients without coagulation disorders are also at risk of massive life-threatening bleeding and need strict follow-up after ligation.

The short-term clinical outcomes of endoscopic rubber band ligation for grade I~III internal hemorrhoids

“…Therefore, the tension of the ligature site can be reduced by root supplementary ligation and series ligation during ligation, so as to reduce the possibility of band removal. In addition, coagulation disorders [23], taking anti-platelet and/or acetylsalicylic acid [24] can increase the risk of bleeding related to ERBL. It is routinely recommended that patients should stop this medication for at least 1 week prior to, and 2 weeks post ERBL [25].…”

Endoscopic approaches to the management of hemorrhoids

“…There are few severe complications of ERBL that have been reported in the literature. Jiang et al [12 ] recently reported a case of massive gastrointestinal bleeding in a patient without underlying coagulopathy or anticoagulant/antiplatelet use, 7 days after ERBL of grade II hemorrhoids in which all five rubber bands that…”

“…There are few severe complications of ERBL that have been reported in the literature. Jiang et al [12 ▪ ] recently reported a case of massive gastrointestinal bleeding in a patient without underlying coagulopathy or anticoagulant/antiplatelet use, 7 days after ERBL of grade II hemorrhoids in which all five rubber bands that were deployed had slipped off leaving multiple bleeding ulcers at the site. However, more data is needed in the future with larger sample sizes, and with improved standardization of candidate selection and technique, to analyze the serious complications of ERBL, particularly massive gastrointestinal bleeding.…”

Sclerobanding in the treatment of second and third degree hemorrhoidal disease in high risk patients on antiplatelet/anticoagulant therapy without suspension: a pilot study

“…The use of office-based techniques, not requiring anaesthesia and hospitalization, mitigates but does not eliminate this risk. Rubber band ligation (RBL), reported as the most effective ambulatory technique for the treatment of haemorrhoidal disease, may rarely be associated with severe late bleeding (13), often occurring between the 10th and 14th postoperative day, and this risk is increased in patients on anticoagulant therapy (14, 15).…”