Ann Coloproctol.  2016 Oct;32(5):195-198. 10.3393/ac.2016.32.5.195.

Major Pelvic Bleeding Following a Stapled Transanal Rectal Resection: Use of Laparoscopy as a Diagnostic Tool

• Tebala GD
• Khan AQ
• Keane S

• KMID: 2400040
• DOI: http://doi.org/10.3393/ac.2016.32.5.195

Abstract

Stapled transanal rectal resection (STARR) and stapled hemorrhoidopexy (SH) are well-established techniques for treating rectal prolapse and obstructed defecation syndrome (ODS). Occasionally, they can be associated with severe complications. We describe the case of a 59-year-old woman who underwent STARR for ODS and developed a postoperative pelvic hemorrhage. A computed tomography (CT) scan revealed a vast pelvic, retroperitoneal hematoma and free gas in the abdomen. Laparoscopy ruled out any bowel lesions, but identified a hematoma of the pelvis. Flexible sigmoidoscopy showed a small leakage of the rectal suture. The patient was treated conservatively and recovered completely. Surgeons performing STARR and SH must be aware of the risk of this rare, but severe, complication. If the patient is not progressing after a STARR or SH, a CT scan can be indicated to rule out intra-abdominal and pelvic hemorrhage. Laparoscopy is a diagnostic tool and should be associated with intraluminal exploration with flexible sigmoidoscopy.

Keyword

Rectal prolapse; Laparoscopy; Postoperative hemorrhage

MeSH Terms

Abdomen
Defecation
Female
Hematoma
Hemorrhage*
Humans
Laparoscopy*
Middle Aged
Pelvis
Postoperative Hemorrhage
Rectal Prolapse
Sigmoidoscopy
Surgeons
Sutures
Tomography, X-Ray Computed