J Korean Surg Soc.  2011 Dec;81(Suppl 1):S39-S42. 10.4174/jkss.2011.81.Suppl1.S39.

Edematous and painful external hemorrhoids following intersphincteric resection for low rectal cancer

• Leong QM
• Son DN
• Baek SJ
• Cho JS
• Amar A
• Kwak JM
• Kim SH

• KMID: 1445783
• DOI: http://doi.org/10.4174/jkss.2011.81.Suppl1.S39

Abstract

Intersphincteric resection (ISR) is the ultimate sphincter saving procedure for low rectal cancer. Hemorrhoids are a common benign condition. We present and discuss a case of ISR which developed painful edematous hemorrhoids after ISR. A 62-year-old female with low rectal cancer received neoadjuvant chemoradiotherapy with successful down staging of tumor before undergoing robot assisted ISR with coloanal hand-sewn anastomosis. She had pre-existing external hemorrhoids which were not excised. She developed painful and edematous external hemorrhoids 4 days after surgery. These were treated conservatively before discharge. Many colorectal surgeons performing ISR have experienced similar situations in their patients, but none have reported on this phenomenon. We discuss the possible factors that may contribute to this situation. A possible solution is prophylactic excision of the hemorrhoids during coloanal anastomosis. Painful hemorrhoids may occur after ISR and if managed conservatively, the outcome is skin tags.

Keyword

Hemorrhoids; Intersphincteric resection; Rectal neoplasms

MeSH Terms

Chemoradiotherapy
Female
Hemorrhoids
Humans
Middle Aged
Rectal Neoplasms
Skin

Figure

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  Fig. 1 Painful edematous external hemorrhoids postoperative day 4.

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  Fig. 2 Skin tags post intersphincteric resection.

Reference

1. Meyer JE, Narang T, Schnoll-Sussman FH, Pochapin MB, Christos PJ, Sherr DL. Increasing incidence of rectal cancer in patients aged younger than 40 years: an analysis of the surveillance, epidemiology, and end results database. Cancer. 2010. 116:4354–4359.

2. Kuo LJ, Liu MC, Jian JJ, Horng CF, Cheng TI, Chen CM, et al. Is final TNM staging a predictor for survival in locally advanced rectal cancer after preoperative chemoradiation therapy? Ann Surg Oncol. 2007. 14:2766–2772.

3. Teramoto T, Watanabe M, Kitajima M. Per anum intersphincteric rectal dissection with direct coloanal anastomosis for lower rectal cancer: the ultimate sphincter-preserving operation. Dis Colon Rectum. 1997. 40:10 Suppl. S43–S47.

4. Yamada K, Ogata S, Saiki Y, Fukunaga M, Tsuji Y, Takano M. Long-term results of intersphincteric resection for low rectal cancer. Dis Colon Rectum. 2009. 52:1065–1071.

5. Luca F, Cenciarelli S, Valvo M, Pozzi S, Faso FL, Ravizza D, et al. Full robotic left colon and rectal cancer resection: technique and early outcome. Ann Surg Oncol. 2009. 16:1274–1278.

6. Johanson JF, Sonnenberg A. The prevalence of hemorrhoids and chronic constipation. An epidemiologic study. Gastroenterology. 1990. 98:380–386.

7. Cintron JR, Abcarian H. Wolff BG, Fleshman JW, Beck DE, Pemberton JH, Wexner SD, editors. Benign anorectal: hemorrhoids. The ASCRS textbook of colon and rectal surgery. 2007. New York: Springer Publishers;156–177.

8. Baeten CI, Castermans K, Lammering G, Hillen F, Wouters BG, Hillen HF, et al. Effects of radiotherapy and chemotherapy on angiogenesis and leukocyte infiltration in rectal cancer. Int J Radiat Oncol Biol Phys. 2006. 66:1219–1227.

9. Kruse JJ, te Poele JA, Russell NS, Boersma LJ, Stewart FA. Microarray analysis to identify molecular mechanisms of radiation-induced microvascular damage in normal tissues. Int J Radiat Oncol Biol Phys. 2004. 58:420–426.

10. Seifert WF, Verhofstad AA, Wobbes T, Lange W, Rijken PF, van der Kogel AJ, et al. Quantitation of angiogenesis in healing anastomoses of the rat colon. Exp Mol Pathol. 1997. 64:31–40.