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Rectal Perforation After Procedure for Prolapse and Hemorrhoids: Possible Causes

Gao, Xian Hua Ph.D.1; Wang, Han Tao M.D.1; Chen, Ji Gui Ph.D.2; Yang, Xiao Dong Ph.D.3; Qian, Qun Ph.D.4; Fu, Chuan Gang M.D.1

doi: 10.1007/DCR.0b013e3181ed423b
Original Contribution
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PURPOSE: Our aim was to explore possible causes of rectal perforation occurring in patients who undergo the procedure for prolapse and hemorrhoids.

METHODS: 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.

RESULTS: 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.

CONCLUSION: 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: fugang416@126.com

© The ASCRS 2010