Non-operative management of intra-abdominal bleeding and retroperitoneal hematoma after stapling procedure for prolapsed hemorrhoids

Stapling procedure for prolapsed hemorrhoids (PPh) is a widely accepted surgical procedure for third-degree hemorrhoids. intra-abdominal hemorrhage with retroperitoneal hematoma is an uncommon but possible complication. We report on the non-operative management of a case of intra-abdominal bleeding and retroperitoneal hematoma after PPh in a 56-year-old healthy woman presenting third-degree internal hemorrhoids. On the first postoperative day, the patient developed acute back pain, abdominal pain, abdominal distension with clinical signs of peritoneal irritation at left iliac fossa and hypogastrium and a drop in hemoglobin (hb 7.6 mg/dL). Computed tomography (CT) of the abdomen showed intra-abdominal free blood and an anterior intraparietal hematoma of the rectum. She was treated conservatively with intravenous fluids, antibiotics and analgesia. at the third postoperative day, the hematoma drained through surgical wound spontaneously. The patient was discharged 7 days after the operation with normal bowel movements. At 2 weeks after surgery a CT of control pointed out total resolution of perirectal hematoma. No evidence of clinical problems one month after surgery. The non-operative management of intra-abdominal hemorrhage with retroperitoneal hematoma can be successful in selected patients with hemodynamic stability and no evidence of arterial blushings or pneumoperitoneum at CT.