Massive Rectal Bleeding After Rubber Band Ligation of Internal Hemorrhoids: A Case Report

Rubber band ligation (RBL) is a common treatment for internal hemorrhoids. Although generally safe, complications such as delayed bleeding can occur, particularly in patients taking anticoagulants, antiplatelets, or nonsteroidal anti-inflammatory drugs (NSAIDs).

A 34-year-old White woman presented with massive rectal bleeding 15 days after suction RBL of internal hemorrhoids. She was not taking anticoagulants, antiplatelets, or NSAIDs and had no history of bleeding disorders. Flexible sigmoidoscopy revealed a 10-mm ulcer with a visible vessel at the previous banding site. Hemostasis was achieved with clip placement and hemostatic spray. She recovered without further complications.

Massive bleeding following RBL is rare, especially in patients without traditional bleeding risk factors. Literature review identified only one similar case. Most reported cases involve patients on aspirin or other blood-thinning agents. This case adds to the limited data on severe post-RBL bleeding in low-risk individuals and highlights the potential for delayed presentation.

This case highlights the potential for delayed and significant bleeding post-RBL, even in patients without traditional bleeding risk factors. Vigilance beyond the immediate postoperative period is essential, and patients should be counseled on signs of delayed complications.