Management of rectal bleeding due to internal haemorrhoids with arterial embolisation: a single-centre experience and protocol.

AIM: To evaluate the safety and efficacy of arterial embolisation for rectal bleeding due to internal haemorrhoids.

MATERIALS AND METHODS: Twenty-three patients received arterial embolisation for rectal bleeding due to internal haemorrhoids. Clinical records, technical success, and complications were analysed retrospectively.

RESULTS: Good short-term outcomes were achieved with no ischaemia or pain. Regarding symptom resolution, such as irritation, discomfort, and bloody discharge, satisfaction was observed in 6/6 (100%) patients with grade II haemorrhoids and 14/17 (82.35%) patients with grade III haemorrhoids. In the study, nine of the 10 patients (10/23, 43.48%) whose superior rectal artery (SRA) had a connection with the inferior rectal artery (IRA), either unilaterally or bilaterally, had embolisation of the IRA performed. Re-bleeding was observed in two (2/23, 8.7%) patients, including one whose connection between the right SRA and right IRA was not previously noted. A reduction in the size of the haemorrhoid was observed by rectoscopy 1 month later (mean 1.91 cm versus 1.25 cm; p<0.05). The contractility of the internal and external sphincters was normal in all cases.

CONCLUSION: Coil embolisation of the haemorrhoid arteries for rectal bleeding is technically feasible, safe, and well tolerated. It is proposed that embolisation of the SRA and IRA is necessary in cases where connections between the arteries are noted.