Meshikhes Abdul-Wahed N, Issa Hussain
Department of Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia.
Case Rep Gastroenterol. 2010 Jun 19;4(2):204-209. doi: 10.1159/000316634.
Early bleeding after stapled haemorrhoidectomy (SH) is not uncommon. Late and persistent bleeding occurring weeks or months after SH, however, is rare; it has only been described in more than 10% of cases. It is attributed to the development of inflammatory polyps at the staple line. Occurrence of rectal bleeding in the presence of palpable polypoid lesions at the stapled anastomotic line can cause diagnostic confusions, and it is not uncommon that such lesions are initially confused with rectal carcinoma. We report a case of a 38-year-old male who presented with persistent rectal bleeding some 6 months after SH performed in another hospital. Rectal and colonoscopic examinations revealed polypoid lesions at the anastomotic line. The biopsy failed to confirm malignancy, but identified cytomegalovirus (CMV) infection. The development of multiple inflammatory polypoid lesions in conjunction with CMV infection at the stapled anastomotic line has caused a diagnostic confusion, but - after exclusion of cancer - this complication was efficiently treated by CMV infection eradication combined with surgical excision of the remaining polyps due to persistence of bleeding. This case is reported to highlight late bleeding due to inflammatory polyps after SH and to increase the awareness of surgeons and gastroenterologists of this benign but somewhat common complication.
吻合器痔切除术（SH）后早期出血并不少见。然而，SH数周或数月后发生的晚期持续性出血则较为罕见，仅有超过10%的病例有相关描述。其原因是吻合口处炎性息肉的形成。在吻合口处可触及息肉样病变的情况下出现直肠出血会导致诊断混淆，这类病变最初被误诊为直肠癌的情况并不少见。我们报告一例38岁男性患者，在另一家医院接受SH约6个月后出现持续性直肠出血。直肠和结肠镜检查发现吻合口处有息肉样病变。活检未能确诊为恶性肿瘤，但发现了巨细胞病毒（CMV）感染。吻合口处多个炎性息肉样病变合并CMV感染导致了诊断混淆，但在排除癌症后，由于出血持续存在，通过根除CMV感染并结合手术切除剩余息肉有效治疗了这一并发症。报道该病例是为了强调SH后炎性息肉导致的晚期出血，并提高外科医生和胃肠病学家对这种良性但较为常见并发症的认识。
