[Rectal perforation as a result of stapled hemorrhoidectomy]

The procedure for prolapsing hemorrhoids (PPH) has the potential to overcome many of the disadvantages of excisional hemorrhoidectomy; nevertheless, rare serious postoperative complications have been reported.

We present a case of a 31-year-old male who was admitted and treated at another hospital with a stapled mucosectomy, which was carried out using a PPH01 33-mm stapling device. During the immediate postoperative period a fistula presented from the rectum to the right gluteus and a primary closure was attempted. However, the patient continued with the same symptoms and was referred to our hospital in October 2009. On examination at our Department of Colorectal Surgery, a right gluteus abscess was found and a primary orifice in the rectum with a diameter of 10 mm at 4 cm from the anal verge, confirmed with magnetic resonance imaging. A primary closure was attempted; however, during follow-up the patient presented edema, erythema and induration of the right gluteus and a failed closure of the fistula. Afterwards an endorectal advancement flap was successful in the closure of the fistula.

Complications with PPH may compromise function or may be life-threatening for the patient, requiring further surgeries with increased morbidity and mortality. Therefore, it is recommended to be performed by surgeons with special training in this procedure.