Rectal free perforation after stapled hemorrhoidopexy: A case report of laparoscopic peritoneal lavage and repair without stoma.

INTRODUCTION: Stapled hemorrhoidopexy is widely performed for treatment of prolapsed hemorrhoids because of advantages, including shorter hospital stay and less discomfort, compared with conventional hemorrhoidectomy. However, it can have severe adverse effects, such as rectal bleeding, perforation, and sepsis.

PRESENTATION OF CASE: We report the case of a healthy 28-year-old man who presented to the emergency department with sudden-onset diffuse abdominal pain and hematochezia. He had undergone stapled hemorrhoidopexy 5days earlier and was discharged after an uneventful postoperative course. For the present condition, after immediate evaluation, we successfully performed emergency laparoscopic repair of the rectal perforation without any stoma. His postoperative course was uneventful, and he was discharged on postoperative day 16.

DISCUSSION: This is a rare case of rectal perforation after stapled hemorrhoidopexy in which the perforation was treated successfully by laparoscopic repair. In most cases of rectal perforation following stapled hemorrhoidopexy, surgeons perform open laparotomy and create diverting stoma. However, our patient underwent totally laparoscopic lavage and primary closure without diverting stoma. Multiple investigators have reported that laparoscopic lavage for perforated diverticulitis may be an appropriate treatment option. Factors favoring this approach include early surgery, young age, sufficient irrigation, and meticulous primary closure.

CONCLUSION: Stapled hemorrhoidopexy can have severe adverse effects, such as rectal bleeding, pelvic sepsis, and rectal perforation, which are potentially life-threatening. Laparoscopic lavage and primary repair without stoma can be performed successfully in select patients with rectal perforation following stapled hemorrhoidopexy.