Severe intra-abdominal bleeding leading to hemorrhagic shock, rectal perforation and bilateral hydrothorax after stapling procedure for prolapsed hemorrhoids

Excerpt

A 44-year-old male had a PPH for circumferential prolapsed hemorrhoids. Soon after returning to the ward, the patient complained of moderate abdominal pain and tenesmus, which developed subsequently into rectal bleeding resulting in a deterioration of the vital signs. Abdominal CT exanimation showed rectal wall hematoma and pelvic collection. An emergency explorative laparotomy was performed, and the seromuscular laceration was apparent on the anterior rectal wall at the level of peritoneal reflection. A double-barreled colostomy was performed in the left iliac fossa (Fig. 1). One abdominal drain and additional transanal abdominal drain and anal drain were well placed (Figs. 2, 3, 4). However, the patient developed fever (38 °C), tachypnea (30–40/min) and tachycardia (130 bpm) on the third postoperative day. Chest CT examination demonstrated bilateral hydrothorax resulting in pulmonary atelectasis (Fig. 5). Thoracocentesis was carried out. Since then, the patient underwent a uneventful recovery, and the colostomy was then closed 6 months later.

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