Our aim was to explore possible causes of rectal perforation occurring in patients who undergo the procedure for prolapse and hemorrhoids.
We evaluated data from cases of rectal perforation that occurred after the procedure for prolapse and hemorrhoids in China in conjunction with case reports from the international medical literature.
We identified 7 patients from 5 hospitals in 2 provinces of China who had rectal perforation after the procedure despite having received prophylactic antibiotic treatment. Two patients had a disrupted staple line and 5 had perforations on the rectum wall above the intact staple line. Six patients presented with symptoms in the first 3 days after the procedure. Three patients had concomitant disease: 1 had concomitant constipation and internal rectal prolapse, 1 had concomitant constipation, and 1 had concomitant liver cirrhosis ascites that was not diagnosed preoperatively. Of the 15 cases of rectal perforation found in the literature, 3 patients had an intact staple line and 5 patients had a ruptured staple line.
The cone-shaped tip of the anvil, concomitant rectal prolapse and pelvic floor descent, and concomitant ascites are possible causes of rectal perforation after the procedure for prolapse and hemorrhoids.
1 Department of Colorectal Surgery of Changhai Hospital, Second Military Medical University, Shanghai, China
2 Department of Colorectal Surgery of the Eighth Hospital of Wuhan City, Wuhan, Hubei Province, China
3 Department of GI Surgery of Shenzhen People's Hospital, Shenzhen, Guangdong Province, China
4 Department of Colorectal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
Financial Disclosure: None reported.
Xian Hua Gao and Han Tao Wang contributed equally to this study.
Correspondence: Chuan Gang Fu, M.D., Department of Colorectal Surgery of Changhai Hospital, Second Military Medical University, Shanghai 200433, China. E-mail: email@example.com