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Published on: April 17, 2019
Post hemorrhoidectomy complications: CT imaging findings
Eyal Klang1, Tamer Sobeh1, Marianne Michal Amitai1
1Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Israel.
Insights
Computed tomography (CT) can identify severe early complications after hemorrhoidectomy, such as rectal perforation and abscesses. Emergency department (ED) radiologists must recognize these findings to prevent serious patient outcomes.
Area of Science:
- Radiology
- Gastroenterology
- Emergency Medicine
Background:
- Hemorrhoidectomy is a common procedure.
- Early complications can arise post-procedure.
- Computed tomography (CT) is utilized in emergency departments (EDs).
Purpose of the Study:
- To describe CT findings of early complications after interventional hemorrhoid treatments.
- To highlight potential severe outcomes in ED patients.
Main Methods:
- Retrospective review of abdominal/pelvic CT scans from February 2012 to February 2019.
- Inclusion criteria: ED patients with suspected early (≤30 days) post-hemorrhoidectomy complications.
- Data collected: presenting symptoms, CT findings, clinical outcomes.
Main Results:
- 12 patients underwent CT for post-hemorrhoidectomy complications.
- Common symptoms: peri-anal/abdominal pain; one patient had hemodynamic instability.
- CT findings included proctitis (4/12), rectal perforation (2/12), peri-anal abscess (1/12), and fistula (1/12).
- Three patients required intensive care; two underwent emergent laparotomy; one patient died from secondary infection.
Conclusions:
- Hemorrhoidectomy can lead to severe, recognizable complications.
- These complications pose a significant clinical risk.
- ED clinicians and radiologists need awareness of these potential post-procedural issues.
Introduction:
We aimed to describe computed tomography (CT) findings of early complications after interventional hemorrhoid treatments in emergency department (ED) patients.
Materials And Methods:
We identified all ED patients requiring abdominal and/or pelvic CT between February 2012 and February 2019, and included only patients who underwent CT for suspected early (up to 30 days) post hemorrhoidectomy procedure complications. Presenting symptoms, salient CT findings and clinical outcomes were collected.
Results:
Overall, 48,425 abdominal and/or pelvic CTs were performed. Of these, we identified 12 patients (8 male, 4 female) who underwent CT in our ED following hemorrhoidectomy procedures. At presentation, peri-anal or abdominal pain was the most common symptom. One patient presented with hemodynamic instability. CT findings included proctitis (4/12), rectal perforation (2/12), peri-anal abscess (1/12) and peri-anal fistula (1/12). Two of the patients with proctitis presented with significant submucosal edema. On follow-up, three patients required intensive care hospitalization, and two of those underwent emergent laparotomy. The third patient died due to secondary infection during his hospitalization.
Conclusion:
Hemorrhoidectomy procedures may result in severe complications which should be recognized by ED radiologists. These complications carry a potential risk for significant clinical consequences. Both clinicians and radiologists should be aware of the possibility of such complications when patients present to the ED early after hemorrhoid procedures.
