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Brain abscess after transanal hemorrhoidal dearterialization: a case report.
A E M Berkel1, M E Witte, R Koop
1Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands.
Case Reports in Gastroenterology
|June 7, 2013
Summary
Transanal hemorrhoidal dearterialization (THD) is a new hemorrhoid treatment. A rare brain abscess caused by Streptococcus milleri occurred after THD in a healthy man, highlighting a previously undescribed complication.
Area of Science:
- Neurology
- Infectious Diseases
- Gastroenterology
Background:
- Transanal hemorrhoidal dearterialization (THD) is an increasingly utilized minimally invasive procedure for hemorrhoid treatment.
- Brain abscesses are typically associated with other sources of infection, and their occurrence post-THD is not documented.
Observation:
- A healthy 51-year-old male developed neurological symptoms including headache, cognitive decline, and left hemiplegia two weeks after undergoing THD.
- Cranial imaging revealed a significant right temporoparieto-occipital brain abscess with surrounding edema and ventricular compression.
- Cerebrospinal fluid analysis identified Streptococcus milleri as the causative agent.
Findings:
- The patient required surgical intervention, including ventriculoscopy for abscess drainage and subsequent placement of external and ventriculoperitoneal drains due to hydrocephalus.
- Treatment with intravenous antibiotics and dexamethasone was initiated.
- Neurological deficits, including hemiplegia and cognitive impairment, showed improvement following intervention.
Implications:
- This case highlights a severe, previously unreported complication of Streptococcus milleri brain abscess following transanal hemorrhoidal dearterialization.
- It underscores the importance of considering rare infectious complications even after seemingly straightforward procedures.
- Further investigation into the potential mechanisms and risk factors for such complications may be warranted.
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