Annals of Coloproctology

Original Articles

Benign GI diease,Benign diesease & IBD,Complication,Surgical technique

Efficacy and Safety of Endoscopic Clipping for Acute Anastomotic Bleeding After Colorectal Surgery: Ryun Kyong Ha, Kyung Su Han, Sung Sil Park, Dae Kyung Sohn, Chang Won Hong, Byung Chang Kim, Bun Kim; Ann Coloproctol. 2022;38(3):262-265. Published online October 26, 2021; DOI: https://doi.org/10.3393/ac.2021.00297.0042

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Purpose
Anastomotic bleeding after colorectal surgery is a rare, mostly self-limiting, postoperative complication that could lead to a life-threatening condition. Therefore, prompt management is required. This study aimed to evaluate the efficacy and safety of endoscopic clipping for acute anastomotic bleeding after colorectal surgery.
Methods
We retrospectively reviewed the data of patients pathologically diagnosed with colorectal cancer at National Cancer Center, Korea from January 2018 to November 2020, which presented with anastomotic bleeding within the first postoperative week and were endoscopically managed with clips.
Results
Nine patients had anastomotic bleeding, underwent endoscopic management, and, therefore, were included in this study. All patients underwent laparoscopic (low/ultralow) anterior resection with mechanical double-stapled anastomosis. Anastomotic bleeding was successfully managed through a colonoscopy with clips on the first trial in all patients. Hypovolemic shock occurred in one patient, following anastomotic breakdown.
Conclusion
Endoscopic clipping seems to be an effective and safe treatment for anastomotic bleeding with minimal physiologic stress, easy accessibility, and scarce postoperative complications. However, a surgical backup should always be considered for massive bleeding.

Citations

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Post-Surgical Imaging Assessment in Rectal Cancer: Normal Findings and Complications
Federica De Muzio, Roberta Fusco, Carmen Cutolo, Giuliana Giacobbe, Federico Bruno, Pierpaolo Palumbo, Ginevra Danti, Giulia Grazzini, Federica Flammia, Alessandra Borgheresi, Andrea Agostini, Francesca Grassi, Andrea Giovagnoni, Vittorio Miele, Antonio B
Journal of Clinical Medicine.2023; 12(4): 1489. CrossRef
Preventing Anastomotic Leakage, a Devastating Complication of Colorectal Surgery
Hyun Gu Lee
The Ewha Medical Journal.2023;[Epub] CrossRef

Benign diesease & IBD,Surgical technique

Transanal rectopexy for external rectal prolapse: Shantikumar Dhondiram Chivate, Meghana Vinay Chougule, Rahul Shantikumar Chivate, Palak Harshuk Thakrar; Ann Coloproctol. 2022;38(6):415-422. Published online October 21, 2021; DOI: https://doi.org/10.3393/ac.2021.00262.0037

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Abstract PDF

Purpose
The surgical management of patients with full-thickness rectal prolapse (FTRP) continues to remain a challenge in the laparoscopic era. This study retrospectively assesses a cohort of patients undergoing a transanal suture sacro rectopexy supported by sclerosant injection into the presacral space under ultrasound guidance.
Methods
Patients with FTRP underwent a sutured transrectal presacral fixation of 2/3 of the circumference of the rectum from the third sacral vertebra to the sacrococcygeal junction through a side-viewing operating proctoscope. The procedure was supplemented by ultrasound-guided injection into the retrorectal space of a 2 mL solution of sodium tetradecyl sulfate/polidocanol mixed with air. Patients were functionally assessed before and 6 months after surgery with the Agachan constipation score and the Pescatori incontinence score.
Results
There were 36 adult patients (26 males; the range of age, 23–92 years). The mean operative time was 27 minutes (range, 23–50 minutes) with no recorded perioperative morbidity. The median follow-up was 66 months (range, 48–84 months) with 1 (2.8%) recurrence presenting 18 months after surgery. There were 19 patients (52.8%) who presented with incontinence before surgery with 17 out of 19 (89.5%) reporting improvement in their Pescatori score (P<0.001). No patient had worsening incontinence and there were no de novo incontinence cases. Constipation scores improved in 23 out of 36 patients (63.9%) with a mean score reduction difference of 7.91 (P=0.001).
Conclusion
Transanal sutured sacral rectopexy with supplemental presacral sclerosant injection is safe and effective in the management of FTRP with sustained improvement in bowel function.

Citations

Citations to this article as recorded by

Systematic literature review and meta-analysis of surgical treatment of complete rectal prolapse in male patients
S. H. Emile, A. Wignakumar, N. Horesh, Z. Garoufalia, V. Strassmann, M. Boutros, S. D. Wexner
Techniques in Coloproctology.2024;[Epub] CrossRef
External rectal prolapse: more than meets the eye
M. Yiasemidou, C. Yates, E. Cooper, R. Goldacre, I. Lindsey
Techniques in Coloproctology.2023; 27(10): 783. CrossRef

Case Report

Benign proctology,Complication,Biomarker & risk factor

Recurrent bleeding after posthemorrhoidectomy caused by factor V deficiency: a case report and review of the literature: Jun Seong Chung, Han Deok Kwak, Jae Kyun Ju; Ann Coloproctol. 2022;38(6):449-452. Published online July 27, 2021; DOI: https://doi.org/10.3393/ac.2021.00185.0026

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Abstract PDF

Congenital factor V (FV) deficiency is a rare hemorrhagic disorder that can cause excessive bleeding during and after surgery in the affected patient. This report is the case of a patient who had FV deficiency with recurrent posthemorrhoidectomy bleeding treated with the hemostatic procedure and fresh frozen plasma (FFP) transfusions. A 45-year-old male patient had previously undergone hemorrhoidectomy for multiple hemorrhoids at a local hospital. Hemorrhoidectomy was successful; however, he was transferred to our hospital for evaluation of the origin of the recurrent posthemorrhoidectomy bleeding and underwent a hemostatic procedure. This bleeding was treated with coagulation using electrocautery, multiple sutures, and FFP transfusion (1,600 mL/day) for 7 consecutive days. The patient’s plasma FV activity was 23%. Early detection of clotting factor deficiency in patients with hemorrhagic events after surgical treatments may prevent unnecessary procedures such as reoperations and minimize the cost of replacement therapy such as large-volume FFP transfusion.

Citations

Citations to this article as recorded by

Rare Inherited Coagulation Deficiencies: A Single-center Study
Özlem Terzi, Sadik Sami Hatipoğlu
Journal of Pediatric Hematology/Oncology.2025; 47(2): e90. CrossRef
Plasma/tranexamic-acid/vitamin-k

Reactions Weekly.2023; 1954(1): 383. CrossRef

Original Article

Benign proctology,Complication,Biomarker & risk factor

Frequency and risk factors of severe postoperative bleeding after proctological surgery: a retrospective case-control study: Sarah Taieb, Patrick Atienza, Jean-David Zeitoun, Milad Taouk, Josée Bourguignon, Christian Thomas, Nabila Rabahi, Saliha Dahlouk, Anne-Carole Lesage, David Lobo, Isabelle Etienney; Ann Coloproctol. 2022;38(5):370-375. Published online July 27, 2021; DOI: https://doi.org/10.3393/ac.2021.00122.0017

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Abstract PDF

Purpose
The aim of this study was to assess frequency and risk factors of severe bleeding after proctological surgery requiring hemostatic surgery observed after publication of the French guidelines for anticoagulant and platelet-inhibitor treatment.
Methods
All patients who underwent proctological surgery between January 2012 and March 2017 in a referral center were included. Delay, severity of bleeding, and need for blood transfusion were recorded. Patients with severe postoperative bleeding were matched to controls at a 2:1 ratio adjusted on the operator, and the type of surgery.
Results
Among the 8,890 operated patients, 65 (0.7%) needed a postoperative hemostatic procedure in an operating room. The risk of a hemostatic surgery was significantly increased after hemorrhoidal surgery compared with other procedures (1.9% vs. 0.5%, P<10^–4) and was most frequent after Milligan-Morgan hemorrhoidectomy (2.5%). Mean bleeding time was 6.2 days and no bleeding occurred after day 15. Blood transfusion rate was 0.1%. Treatment with anticoagulants and platelet inhibitors were managed according to recommendations and did not increase the severity of bleeding. The risk of severe bleeding was significantly lower in active smokers vs. non-smokers in univariate (16.9% vs. 36.2%, P=0.007) and multivariate (odds ratio, 0.31; 95% confidence interval, 0.14–0.65) analysis whereas sex, age, and body mass were not significantly associated with bleeding.
Conclusion
Severe postoperative bleeding occurs in 0.7% of patients, but varies with type of procedure and is not affected by anticoagulant or antiplatelet treatment. These treatments given in accordance with the new guidelines do not increase the severity of postoperative bleeding.

Citations

Citations to this article as recorded by

Efficacy of Endoscopic Evaluation and Hemostatic Intervention for Post-hemorrhoidectomy Bleeding
Katsuhisa Ohashi, Katsuhide Ohashi, Akinori Sasaki, Kazuyoshi Ota, Kazutomo Kitagawa
Journal of the Anus, Rectum and Colon.2025; 9(1): 162. CrossRef
Evaluation of Clinical Manifestations of Hemorrhoidal Disease, Carried Out Surgeries and Prolapsed Anorectal Tissues: Associations with ABO Blood Groups of Patients
Inese Fišere, Valērija Groma, Šimons Svirskis, Estere Strautmane, Andris Gardovskis
Journal of Clinical Medicine.2023; 12(15): 5119. CrossRef
Sclerobanding in the treatment of second and third degree hemorrhoidal disease in high risk patients on antiplatelet/anticoagulant therapy without suspension: a pilot study
Francesco Pata, Luigi M. Bracchitta, Bruno Nardo, Gaetano Gallo, Giancarlo D’Ambrosio, Salvatore Bracchitta
Frontiers in Surgery.2023;[Epub] CrossRef
Principles of minimize bleeding and the transfusion of blood and its components in operated patients – surgical aspects
Tomasz Banasiewicz, Waldemar Machała, Maciej Borejsza Wysocki, Maciej Lesiak, Sebastian Krych, Małgorzata Lange, Piotr Hogendorf, Adam Durczyński, Jarosław Cwaliński, Tomasz Bartkowiak, Adam Dziki, Wojciech Kielan, Stanisław Kłęk, Łukasz Krokowicz, Krzysz
Polish Journal of Surgery.2023; 95(5): 14. CrossRef

Case Reports

Benign diesease & IBD,Rare disease & stoma

Calcium polystyrene sulfonate associated colonic mucosal injury—innocent bystander or pathogenic culprit?: a case report and literature review: Setthachai Piwchan, Ekawee Sripariwuth, Peerayut Sitthichaiyakul; Ann Coloproctol. 2022;38(6):453-456. Published online May 28, 2021; DOI: https://doi.org/10.3393/ac.2021.03.19

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Abstract PDF

Colonic mucosal injury is rare, but may severely fatal, complications following the administration of calcium polystyrene sulfonate resins. The incidence rate is about 0.57%, administered without sorbitol, and increases to 1.8% when it is concomitant with sorbitol, especially in postoperative patients. In this case report, we demonstrated the case of a 77-year-old female with stage 3b chronic kidney disease presented with in-hospital hematochezia after 3 weeks of calcium polystyrene sulfonate administration. The colonoscopic findings showed several serpiginous ulcers with some oozing at descending and sigmoid colon. The histological findings revealed some focal inflammation and ulcerations with crystal-like materials, compatible with cation exchange resins. The recent in vitro study, explaining the pathogenesis of cation exchange resin-associated colonic mucosal injury, was also reviewed.

Citations

Citations to this article as recorded by

Crystals in the Colon: A Surprising Culprit Behind Massive GI Bleeding in End‐Stage Renal Disease
Chi Hyuk Oh, Ji Eun Kim, Chang Kyun Lee
Journal of Gastroenterology and Hepatology.2025; 40(2): 349. CrossRef
Calcium Polystyrene Sulfonate Crystal-related Airway Obstruction
Hideshige Seki, Kensuke Narukawa, Yurika Mitsui, Yukari Shirasugi, Shigeki Morita, Tsuyoshi Takahashi
Internal Medicine.2024; 63(19): 2699. CrossRef
Calcium polystyrene sulfonate-induced rectal ulcer causing E. coli native-valve infective endocarditis
Shinnosuke Fukushima, Hideharu Hagiya, Hiroyuki Honda, Tomoharu Ishida, Ryohei Shoji, Kou Hasegawa, Fumio Otsuka
Clinical Journal of Gastroenterology.2024; 17(3): 472. CrossRef
Pharmacological intestinal obstruction because of calcium polystyrene sulfonate administration
Benjamin Thorpe, Salustiano Gonzalez Vinagre, Daniel Santos, Javier Caneiro Gomez, Manuel Bustamante Montalvo
Journal of Surgical Case Reports.2024;[Epub] CrossRef
Histopathological lesions of the gastrointestinal tract associated with the use of polystyrene sulfonate and sevelamer: a meta-analysis
Gianluca Di Rienzo, Pellegrino Crafa, Marco Delsante, Enrico Fiaccadori, Giuseppe Pedrazzi, Nicoletta Campanini, Emilia Corradini
Pathologica.2024; 116(4): 216. CrossRef
Calcium-polystyrene-sulfonate

Reactions Weekly.2023; 1944(1): 174. CrossRef

Endoscopic Band Ligation to Treat a Massive Hemorrhoidal Hemorrhage Following a Transrectal Ultrasound-Guided Prostate Biopsy: Nadim Mahmud, Kirk J. Wangensteen; Ann Coloproctol. 2018;34(1):47-51. Published online February 28, 2018; DOI: https://doi.org/10.3393/ac.2018.34.1.47

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Abstract PDF

Prostate cancer is commonly diagnosed by using a transrectal ultrasound (TRUS)-guided biopsy. Although this procedure is usually well tolerated, rarely it may be complicated by massive rectal bleeding. We report a case of a 77-year-old male who underwent a TRUS biopsy and subsequently developed recurrent episodes of rectal bleeding with syncope and anemia requiring the transfusion of multiple units of blood. A sigmoidoscopy revealed the source of the bleeding: a large hemorrhoid on the anterior wall of the rectum with an overlying ulceration. We successfully applied a band to ligate the hemorrhoid, and the patient's condition improved. To our knowledge, this case represents the first report of a successful band ligation to treat massive bleeding from a hemorrhoid that had been punctured in the course of the TRUS biopsy procedure.

Citations

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A case report of urethral corpus cavernosum pseudoaneurysm formation after ultrasound-guided transperineal prostate biopsy
Wang Zhize, Jiayidaer Dannier, Ma Nieying, Xiang Jianjian, Ying Shihong, Yu Jianjun
BMC Urology.2025;[Epub] CrossRef
Endoscopic Therapy in the Management of Patients With Severe Rectal Bleeding Following Transrectal Ultrasound-Guided Prostate Biopsy: A Case-Based Systematic Review
Adnan Malik, Rizwan Ishtiaq, Muhammad Hassan Naeem Goraya, Faisal Inayat, Vinaya V. Gaduputi
Journal of Investigative Medicine High Impact Case Reports.2021;[Epub] CrossRef

Colonic Perforation Secondary to Idiopathic Intramural Hemorrhage: Takashi Sakamoto, Akira Saito, Alan Kawarai Lefor, Tadao Kubota; Ann Coloproctol. 2016;32(6):239-242. Published online December 31, 2016; DOI: https://doi.org/10.3393/ac.2016.32.6.239

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5 Citations

Abstract PDF

Intramural colonic hemorrhage is rare and often secondary to trauma or anticoagulation therapy. Idiopathic intramural hemorrhages in the alimentary tract have rarely been reported. While several reports of spontaneous perforation of an intramural rectal hematoma have been published, no reports of spontaneous perforation in the ascending colon due to a hematoma have. We describe a patient with an ascending colonic perforation secondary to spontaneous intramural hemorrhage. The patient is a 35-year-old male, who presented with acute abdominal pain and no history of trauma. An abdominal computed tomography scan showed a high-density area around the ascending colon, and nonoperative management was instituted. On the eighth hospital day, the pain worsened, and abdominal computed tomography scan showed free air. An emergent right hemicolectomy was performed. Intramural hematoma and ischemia with perforation, with no obvious etiology, were found. The patient was discharged on the 14th postoperative day.

Citations

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A case of gastrointestinal perforation following transarterial embolization for an intramural hematoma after cold snare polypectomy of an adenoma in the transverse colon
Yuu Kodama, Yuji Mizokami, Yuzo Toyama, Hiroyasu Kusaka, Gen Maeda, Shingo Asahara, Ryuji Nagahama, Shin‐ichiro Horiguchi, Hiroki Aoyama
DEN Open.2025;[Epub] CrossRef
Giant Proximal Right Colon Submucosal Hematoma Leading to a Large Bowel Obstruction
Arham Siddiqui, Hijab Ahmed, Muhammad H Nazim, Basem Soliman, Izi Obokhare
Cureus.2022;[Epub] CrossRef
Spontaneous colonic perforation in adults: Evaluation of a pooled case series
Ren Chongxi, Ji Jinggang, Shi Yan, Wang Hongqiao, Liu Yan, Yang Fengshuo
Science Progress.2020;[Epub] CrossRef
Idiopathic intramural hematoma of the right colon. A case report and review of the literature
Rosario Vecchio, Emma Cacciola, Michele Figuera, Renato Catalano, Giuseppe Giulla, Emanuele Rosario Distefano, Eva Intagliata
International Journal of Surgery Case Reports.2019; 60: 16. CrossRef
Intramural Hematoma Causing Hematochezia After Colonoscopy With Polypectomy
Aleksandar Gavrić, Rok Dežman, Sebastian Stefanović, Jan Drnovšek, Borut Štabuc
ACG Case Reports Journal.2019; 6(7): e00129. CrossRef

Major Pelvic Bleeding Following a Stapled Transanal Rectal Resection: Use of Laparoscopy as a Diagnostic Tool: Giovanni Domenico Tebala, Abdul Qayyum Khan, Sean Keane; Ann Coloproctol. 2016;32(5):195-198. Published online October 31, 2016; DOI: https://doi.org/10.3393/ac.2016.32.5.195

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5 Citations

Abstract PDF

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.

Citations

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Severe Postoperative Bleeding After Stapled Hemorrhoidopexy: Incidence and Causes
Huabing Chen, Zaili Tang, Zhousong Wu, Renjie Shi
Indian Journal of Surgery.2021; 83(5): 1223. CrossRef
Update on obstructed defecation syndrome
Reem A. Alharbi
Saudi Surgical Journal.2021; 9(1): 1. CrossRef
Perirectal Hematoma and Intra-Abdominal Bleeding after Stapled Hemorrhoidopexy and STARR—A Proposal for a Decision-Making Algorithm
Georgi Popivanov, Piergiorgio Fedeli, Roberto Cirocchi, Massimo Lancia, Domenico Mascagni, Michela Giustozzi, Ivan Teodosiev, Kirien Kjossev, Marina Konaktchieva
Medicina.2020; 56(6): 269. CrossRef
Common operation, uncommon complication. Bleeding from superior haemorrhoidal artery after minimally invasive procedure for hemorrhoids – a case report
Janavikula Sankaran Rajkumar, Aluru Jayakrishna Reddy, Ravikumar Radhakrishnan, Anirudh Rajkumar, Syed Akbar, Dharmendra Kollapalayam Raman
Journal of Coloproctology.2019; 39(01): 070. CrossRef
A Rare Complication of Stapled Hemorrhoidopexy: Giant Pelvic Hematoma Treated with Super-Selective Percutaneous Angioembolization
Francesco Ferrara, Paolo Rigamonti, Giovanni Damiani, Maurizio Cariati, Marco Stella
Annals of Colorectal Research.2018;[Epub] CrossRef

Hematochezia due to Angiodysplasia of the Appendix: Je-Min Choi, Seung-Hun Lee, Seung-Hyun Lee, Byung-Kwon Ahn, Sung-Uhn Baek; Ann Coloproctol. 2016;32(3):117-119. Published online June 30, 2016; DOI: https://doi.org/10.3393/ac.2016.32.3.117

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Abstract PDF

Common causes of lower gastrointestinal bleeding include diverticular disease, vascular disease, inflammatory bowel disease, neoplasms, and hemorrhoids. Lower gastrointestinal bleeding of appendiceal origin is extremely rare. We report a case of lower gastrointestinal bleeding due to angiodysplasia of the appendix. A 72-year-old man presented with hematochezia. Colonoscopy showed active bleeding from the orifice of the appendix. We performed a laparoscopic appendectomy. Microscopically, dilated veins were found at the submucosal layer of the appendix. The patient was discharged uneventfully. Although lower gastrointestinal bleeding of appendiceal origin is very rare, clinicians should consider it during differential diagnosis.

Citations

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Appendiceal bleeding caused by vascular malformation: A case report
Qin Ma, Jin-Jie Du
World Journal of Clinical Cases.2024; 12(14): 2457. CrossRef
Appendiceal bleeding, a rare yet important cause of lower gastrointestinal bleed
Ayman Tabcheh, Johny Salem, Karim Zodeh, Ammar Ghazale
European Journal of Case Reports in Internal Medicine.2024;[Epub] CrossRef
A rare case of appendiceal haemorrhage causing life-threatening haematochezia
Howard H Y Tang, Daming Pan, Andrew Fitzdowse, Aaron Ow, Stephen Chan, Jason S C Tan
Journal of Surgical Case Reports.2024;[Epub] CrossRef
Beyond the Usual Suspects: Appendiceal Bleeding as the Surprising Cause of Lower Gastrointestinal (GI) Bleeding
Asher Siddiqui, Nowera Zafar, Mahdi Hakiminezhad, Zohaib Jamal, Imran Alam, Zeeshan Khawaja
Cureus.2024;[Epub] CrossRef
WITHDRAWN: Appendiceal bleeding caused by vascular malformation: A case report and literature review
Qin Ma, Jinjie Du
International Journal of Surgery Case Reports.2023; : 108903. CrossRef
Clinical features, treatments and prognosis of appendiceal bleeding: a case series study
Xiao-cun Xing, Jin-lin Yang, Xue Xiao
BMC Gastroenterology.2023;[Epub] CrossRef
Angiodysplasia of the appendix: a diagnostic challenge and the importance of colonoscopy
Obiajulu Johnson, Naomi Mackenzie, Jamil Choudhury, Sanjay Furtado
BMJ Case Reports.2023; 16(12): e255498. CrossRef
Appendiceal bleeding: A case report
Sheng-Yue Zhou, Mao-Dong Guo, Xiao-Hua Ye
World Journal of Clinical Cases.2022; 10(18): 6314. CrossRef
Appendiceal bleeding in an elderly male: a case report and a review of the literature
Yuto Maeda, Seiya Saito, Mayuko Ohuchi, Yuka Tamaoki, Jiro Nasu, Hideo Baba
Surgical Case Reports.2021;[Epub] CrossRef
Acute Eosinophilic Appendicitis: A Rare Cause of Lower Gastrointestinal Hemorrhage
So Ra Ahn, Joo Hyun Lee
The Korean Journal of Gastroenterology.2021; 78(2): 134. CrossRef
Appendix bleeding with painless bloody diarrhea: A case report and literature review
Wanqun Chen, Hong Qiu, Xiaojun Yang, Jinwei Zhang
Open Medicine.2019; 14(1): 735. CrossRef

Original Articles

Comparison of Injection Sclerotherapy Between 5% Phenol in Almond Oil and Aluminum Potassium Sulfate and Tannic Acid for Grade 3 Hemorrhoids: Takaaki Yano, Kenji Yano; Ann Coloproctol. 2015;31(3):103-105. Published online June 30, 2015; DOI: https://doi.org/10.3393/ac.2015.31.3.103

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Abstract PDF

Purpose

Injection sclerotherapy for hemorrhoids has been performed for many years. Currently, 5% phenol in almond oil (PAO) and aluminum potassium sulfate and tannic acid (ALTA) are used as the agents. The purpose of this study was to compare the efficacy of the two agents.

Methods

A retrospective study was conducted involving 135 patients who underwent injection therapy for grade 3 hemorrhoids for the first time between 2013 and 2014 (PAO, 55 patients; ALTA, 80 patients). The efficacy was established as the proportion (%) of patients without symptoms such as hemorrhage and prolapse one year after treatment. We investigated four factors—sex, age, number of hemorrhoids, and agent—that might have an influence on the efficacy.

Results

The efficacies of ALTA and PAO one year after treatment were 75% and 20%, respectively. Only the agent was a significant independent factor (P < 0.01).

Conclusion

The results suggest that ALTA is markedly more useful than PAO for injection sclerotherapy for grade 3 hemorrhoids.

Citations

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Rubber band ligation or shaobei injection for the endoscopic treatment of symptomatic hemorrhoids? A retrospective study
Juan Li, Yongcheng Chen, Sen Liao, Dezheng Lin, MingliSu, Jiancong Hu, Qinghua Zhong, Jiaxin Deng, Jiawei Zhang, Xuefeng Guo
Surgical Endoscopy.2025; 39(3): 1555. CrossRef
Sclerotherapy for hemorrhoidal disease: systematic review and meta-analysis
G. Gallo, A. Picciariello, C. Armellin, E. Lori, G. Tomasicchio, G. L. Di Tanna, G. A. Santoro, M. Alharbi, S. Sorrenti, U. Grossi
Techniques in Coloproctology.2024;[Epub] CrossRef
Aluminum potassium sulfate and tannic acid (ALTA) sclerotherapy for hemorrhoidal disease: a systematic review and meta-analysis
Vasiliki Manaki, Vangelis Bontinis, Alkis Bontinis, Argirios Giannopoulos, Ioannis Kontes, Angeliki Chorti, Kiriakos Ktenidis
Acta Chirurgica Belgica.2024; 124(4): 253. CrossRef
The Italian Unitary Society of Colon-Proctology (Società Italiana Unitaria di Colonproctologia) guidelines for the management of acute and chronic hemorrhoidal disease
Antonio Brillantino, Adolfo Renzi, Pasquale Talento, Luigi Brusciano, Luigi Marano, Maurizio Grillo, Mauro Natale Maglio, Fabrizio Foroni, Alessio Palumbo, Maria Laura Sandoval Sotelo, Luciano Vicenzo, Michele Lanza, Giovanna Frezza, Massimo Antropoli, Cl
Annals of Coloproctology.2024; 40(4): 287. CrossRef
Efficacy and Safety of a New Technique Combining Injection Sclerotherapy and External Hemorrhoidectomy for Prolapsed Hemorrhoids: A Single-center Observational Study
Tatsuya Abe, Masao Kunimoto, Yoshikazu Hachiro, Akane Ito, Kenji Watanabe, Shigenori Ota, Kei Ohara, Mitsuhiro Inagaki, Yusuke Saitoh, Masanori Murakami
Journal of the Anus, Rectum and Colon.2024; 8(4): 331. CrossRef
Shifting Paradigms in Hemorrhoid Management: The Emergence and Impact of Cap-Assisted Endoscopic Sclerotherapy
Xianglu Wang, Xia Wu, Quan Wen, Bota Cui, Faming Zhang
Journal of Clinical Medicine.2024; 13(23): 7284. CrossRef
Sclerotherapy in Hemorrhoids
Anling He, Mingkai Chen
Indian Journal of Surgery.2023; 85(2): 228. CrossRef
Minimally Invasive Treatment for Advanced Hemorrhoids
Hidenori Miyamoto
Journal of the Anus, Rectum and Colon.2023; 7(1): 8. CrossRef
Mid-term outcome of a novel nonexcisional technique using aluminum potassium sulfate and tannic acid sclerotherapy with mucopexy on patients with grade III hemorrhoids
A. Tsunoda, H. Kusanagi
Techniques in Coloproctology.2023; 27(12): 1335. CrossRef
Long-term Outcomes of Aluminum Potassium Sulfate and Tannic Acid Sclerotherapy for Prolapsed Hemorrhoids: A Single-Center, Observational Study
Tatsuya Abe, Masao Kunimoto, Yoshikazu Hachiro, Kei Ohara, Mitsuhiro Inagaki
Diseases of the Colon & Rectum.2022; 65(2): 271. CrossRef
The comeback of hemorrhoidal sclerotherapy?
V. de Parades, M. Aubert, N. Fathallah, A. A. Alam, L. Spindler, P. Benfredj
Techniques in Coloproctology.2022; 26(8): 599. CrossRef
Early postoperative outcomes of a novel nonexcisional technique using aluminum potassium sulfate and tannic acid sclerotherapy with mucopexy on patients with grade III hemorrhoids
Shunya Takada, Akira Tsunoda, Tomoko Takahashi, Hiroshi Kusanagi
Annals of Coloproctology.2022; 38(4): 290. CrossRef
A Stepwise Proposal for Low-Grade Hemorrhoidal Disease: Injection Sclerotherapy as a First-Line Treatment and Rubber Band Ligation for Persistent Relapses
Roberta Tutino, Marco Massani, Leonel Jospin Kamdem Mambou, Paolina Venturelli, Immacolata Della Valle, Giuseppina Melfa, Matilde Micheli, Gaia Russo, Gregorio Scerrino, Sebastiano Bonventre, Gianfranco Cocorullo
Frontiers in Surgery.2022;[Epub] CrossRef
Short-Term Results of Sclerotherapy with 3% Polidocanol Foam for Symptomatic Second- and Third-Degree Hemorrhoidal Disease
Pierluigi Lobascio, Rita Laforgia, Eugenio Novelli, Fabrizio Perrone, Maria Di Salvo, Angela Pezzolla, Mario Trompetto, Gaetano Gallo
Journal of Investigative Surgery.2021; 34(10): 1059. CrossRef
Medical uses for phenol in the urinary tract: A possible forgotten treatment (Review)
Takuya Sadahira, Yuki Maruyama, Toyohiko Watanabe, Takanori Sekito, Yosuke Mitsui, Koichiro Wada, Motoo Araki, Masami Watanabe
Medicine International.2021;[Epub] CrossRef
Finding possible pharmacological effects of identified organic compounds in medicinal waters (BTEX and phenolic compounds)
István Szabó, Csaba Varga
International Journal of Biometeorology.2020; 64(6): 989. CrossRef
Hämorrhoidenoperation
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coloproctology.2020; 42(1): 30. CrossRef
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Only the Size of Resected Polyps Is an Independent Risk Factor for Delayed Postpolypectomy Hemorrhage: A 10-Year Single-Center Case-Control Study: Hee Seok Moon, Sun Wook Park, Dong Hwan Kim, Sun Hyung Kang, Jae Kyu Sung, Hyun Yong Jeong; Ann Coloproctol. 2014;30(4):182-185. Published online August 26, 2014; DOI: https://doi.org/10.3393/ac.2014.30.4.182

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Abstract PDF

Purpose

A colonoscopic polypectomy is an important procedure for preventing colorectal cancer, but it is not free from complications. Delayed hemorrhage after a colonoscopic polypectomy is one infrequent, but serious, complication. The aim of this study was to identify the risk factors for delayed hemorrhage after a colonoscopic polypectomy.

Methods

This was a retrospective case-control study based on medical records from a single gastroenterology center. The records of 7,217 patients who underwent a colonoscopic polypectomy between March 2002 and March 2012 were reviewed, and 92 patients and 276 controls were selected. Data collected included comorbidity, use of antiplatelet agents, size and number of resected polyps, histology and gross morphology of resected polyps, resection method, and use of prophylactic hemostasis.

Results

The average time between the procedure and bleeding was 2.71 ± 1.55 days. Univariate and multivariate analyses revealed that the size of the polyps was the only and most important predictor of delayed hemorrhage after a colonoscopic polypectomy (odds ratio, 2.06; 95% confidence interval, 1.12-1.27; P = 0.03).

Conclusion

The size of resected polyps was the only independent risk factor for delayed bleeding after a colonoscopic polypectomy. The size of a polyp, as revealed by the colonoscopic procedure, may aid in making decisions, such as the decision to conduct a prophylactic hemostatic procedure.

Citations

Citations to this article as recorded by

Complete closure utilizing titanium clips minimizes delayed postpolypectomy bleeding after colorectal endoscopic mucosal resection: a retrospective analysis
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Therapeutic Advances in Gastroenterology.2025;[Epub] CrossRef
Risk factors for delayed colorectal postpolypectomy bleeding: a meta-analysis
Xuzhen Zhang, Xiaoxing Jiang, Liang Shi
BMC Gastroenterology.2024;[Epub] CrossRef
Risk factors of delayed post-polypectomy bleeding after treatment of gastrointestinal polyps with snare-assisted endoscopic sub-mucosal dissection
Xiuyan Lu, Ji Ma
Journal of Minimal Access Surgery.2023; 19(2): 272. CrossRef
Endoscopic management of delayed bleeding after polypectomy of small colorectal polyps: two or more clips may be safe
Xue-Feng Guo, Xiang-An Yu, Jian-Cong Hu, De-Zheng Lin, Jia-Xin Deng, Ming-Li Su, Juan Li, Wei Liu, Jia-Wei Zhang, Qing-Hua Zhong
Gastroenterology Report.2022;[Epub] CrossRef
Blood group O is a risk factor for delayed post-polypectomy bleeding
Hiroto Furuhashi, Akira Dobashi, Naoto Tamai, Nana Shimamoto, Masakuni Kobayashi, Shingo Ono, Yuko Hara, Hiroaki Matsui, Shunsuke Kamba, Hideka Horiuchi, Akio Koizumi, Tomohiko R. Ohya, Masayuki Kato, Keiichi Ikeda, Hiroshi Arakawa, Kazuki Sumiyama
Surgical Endoscopy.2021; 35(12): 6882. CrossRef
Prophylactic clip application for large pedunculated polyps before snare polypectomy may decrease immediate postpolypectomy bleeding
Jae Seung Soh, Myeongsook Seo, Kyung-Jo Kim
BMC Gastroenterology.2020;[Epub] CrossRef
Clinical Practice Guideline for the Management of Antithrombotic Agents in Patients Undergoing Gastrointestinal Endoscopy
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Clinical Endoscopy.2020; 53(6): 663. CrossRef
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The Korean Journal of Gastroenterology.2020; 76(6): 282. CrossRef
Risk factors for delayed hemorrhage after colonoscopic postpolypectomy: Polyp size and operative modality
Changqin Liu, Ruijin Wu, Xiaomin Sun, Chunhua Tao, Zhanju Liu
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Adverse events related to colonoscopy: Global trends and future challenges
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Analysis of Delayed Postpolypectomy Bleeding in a Colorectal Clinic: Do Hyoung Kim, Seok Won Lim; J Korean Soc Coloproctol. 2011;27(1):13-16. Published online February 28, 2011; DOI: https://doi.org/10.3393/jksc.2011.27.1.13

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Abstract PDF

Purpose

The colonoscopic polypectomy has become a valuable procedure for removing precursors of colorectal cancer, but some complications can be occurred. The most common complication after colonoscopic polypectomy is bleeding, which is reported to range from 1% to 6% and which can be immediate or delayed. Because the management of delayed postpolypectomy bleeding could be difficult, the use of preventive technique and reductions of risk factors are essential.

Methods

From January 2007 to December 2008, delayed hemorrhage occurred in 18 of the 1,841 polypectomy patients examined by one endoscopist. These cases were reviewed retrospectively for risk factors, pathologic findings, and treatment methods.

Results

Delayed bleeding occurred in 18/1,841 patients (0.95%). The mean age was 55.9 ± 10.9 years, and the male-to-female ratio was 8:1. The most common site was the right colon (11 cases, 61.1%), and the average polyp size was 9.2 ± 2.8 mm. Delayed bleeding was identified from 1 to 5 days after resection (mean, 1.6 ± 1.2 days). The most common macroscopic type of polyp was a sessile polyp (10 cases, 55.6%), and histologic finding was a tubular adenoma in 13 cases (72.2%). Seventeen cases were treated with clipping for hemostasis and 1 case with epinephrine injection.

Conclusion

The right colon and a sessile polyp were associated with an increase in delayed postpolypectomy bleeding. Reducing risk factors and close observation were essential in high risk patients, and prompt management with hemoclips was effective.

Citations

Citations to this article as recorded by

Delphi consensus statement for the management of delayed post-polypectomy bleeding
Enrique Rodríguez de Santiago, Sandra Pérez de la Iglesia, Diego de Frutos, José Carlos Marín-Gabriel, Carolina Mangas-SanJuan, Raúl Honrubia López, Hugo Uchima, Marta Aicart-Ramos, Miguel Ángel Rodríguez Gandía, Eduardo Valdivielso Cortázar, Felipe Ramos
Therapeutic Advances in Gastroenterology.2025;[Epub] CrossRef
Real-world local recurrence rate after cold polypectomy in colorectal polyps less than 10 mm using propensity score matching
Masashi Saito, Takeshi Yamamura, Masanao Nakamura, Keiko Maeda, Tsunaki Sawada, Eri Ishikawa, Yasuyuki Mizutani, Takuya Ishikawa, Naomi Kakushima, Kazuhiro Furukawa, Eizaburo Ohno, Hiroki Kawashima, Masatoshi Ishigami, Mitsuhiro Fujishiro
World Journal of Gastroenterology.2021; 27(47): 8182. CrossRef
Risk factors for delayed hemorrhage after colonoscopic postpolypectomy: Polyp size and operative modality
Changqin Liu, Ruijin Wu, Xiaomin Sun, Chunhua Tao, Zhanju Liu
JGH Open.2019; 3(1): 61. CrossRef
Do We Perform a Perfect Endoscopic Hemostasis Prophylactically with Argon Plasma Coagulation in Colonic Endoscopic Mucosal Resection?
Yunho Jung, Il Kwun Chung, Young Sin Cho, Tae Hoon Lee, Sang-Heum Park, Ji Sung Lee, Sun Joo Kim
Digestive Diseases and Sciences.2015; 60(10): 3100. CrossRef
Risk Factors for Delayed Post-Polypectomy Bleeding
Min Jung Kwon, You Sun Kim, Song I Bae, Young Il Park, Kyung Jin Lee, Jung Hwa Min, Soo Yeon Jo, Mi Young Kim, Hye Jin Jung, Seong Yeon Jeong, Won Jae Yoon, Jin Nam Kim, Jeong Seop Moon
Intestinal Research.2015; 13(2): 160. CrossRef
Risk factors for delayed post‐polypectomy hemorrhage: A case‐control study
Jeong Ho Kim, Hyun Jeong Lee, Ji Won Ahn, Dae Young Cheung, Jin Il Kim, Soo‐Heon Park, Jae Kwang Kim
Journal of Gastroenterology and Hepatology.2013; 28(4): 645. CrossRef
Serum C-reactive Protein As a Possible Marker to Predict Delayed Hemorrhage After Colonoscopic Polypectomy
Liangqin Wu, Tiemei Han, Xiaoyuan Fan, Wensheng Pan, Chunfu Wang, Hua Zhong, Xinbo Ai, Wanjun Zhang, Xiang Xu, Zaiyuan Ye, Takesh Terai, Nobuhiro Sato, Sumio Watanabe, Undurti N. Das
Medical Science Monitor.2012; 18(8): CR480. CrossRef
Endoscopic mucosal resection with an over-the-counter hyaluronate preparation
Shai Friedland, Shivangi Kothari, Ann Chen, Walter Park, Subhas Banerjee
Gastrointestinal Endoscopy.2012; 75(5): 1040. CrossRef

Case Report

Benign Solitary Cecal Ulcer Accompanied by Massive Lower Gastrointestinal Tract Hemorrhage.: Park, Jong Ik , Park, Sang Su , Kang, Sung Gu , Shin, Dong Gue , Yoon, Jin , Kim, Il Myung; J Korean Soc Coloproctol. 2006;22(6):424-427.

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Abstract PDF: A benign cecal ulcer is an uncommon lesion. The etiology remains unknown, and there are no pathognomonic lesions or symptoms. Lower gastrointestinal tract hemorrhage secondary to benign cecal ulcer is the most common complication. Herein, the case of a 24-year-old man with a benign cecal ulcer presenting with a massive lower gastrointestinal tract hemorrhage requiring transfusion until a exploratory laparotomy and right hemicolectomy, is reported with a review of the literature. Surgical intervention is warranted if malignancy is suspected or if the patient has signs of uncontrollable hemorrhage, perforation, or peritonitis.

Original Articles

Step-by-step Management and Treatment Outcome of Bleeding Control for Anastomosis Site after Low Anterior Resection with Double Stapling Technique.: Kim, Hyuk Mun , Shin, Eung Jin , Song, Ok Pyung , Kim, Jae Joon , Jang, Yong Seok , Park, Rae Kyung , Baek, Moo Joon; J Korean Soc Coloproctol. 2005;21(6):390-395.

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Abstract PDF: PURPOSE
This study reviews our experience with a step- by-step management approach of increasing aggressiveness and evaluates the treatment outcome for intraluminal hemorrhage.
METHODS
The study group was comprised of patients who had experienced intraluminal hemorrhage after a low anterior resection with the double stapling technique from 1999 to 2003. The choice of management was selected according to our step-by-step management protocol, and the outcomes were evaluated for each step, lincluding mortality and complications.
RESULTS
Nine patients (6 males and 3 females, mean age 55 years) were identified, the mean volume of packed RBC transfusion was 2 pints, and the mean distance of the anastomotic site from the anal verge was 6 cm. The median stapler size was 31 mm. The first step was cold saline irrigation and drainage; four of 9 patients were controlled. The second step was retention enema with topical hemostatics; one of remaining 5 patients stopped bleeding. The third step was colonoscopic hypertonic saline injection around the bleeding site with direct colonoscopic electrocauterization, two of remaining 4 patients were controlled. The last step was suturing the bleeding site through the anus, the remaining 2 patients stopped bleeding. One of the 9 patients developed leakage from the anastomotic site after the last step management, three of the 9 patients had long standing ileus, and one of the 9 patients developed acute renal failure after a massive transfusion. There were no postoperative deaths.
CONCLUSIONS
It is safer and easier to control bleeding with step-by-step management system of increasing aggressiveness.

Post-hemorrhoidectomy Secondary Hemorrhage.: Choi, Dong Ha; J Korean Soc Coloproctol. 2005;21(5):271-278.

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Abstract PDF: PURPOSE
Post-hemorrhoidectomy secondary hemorrhage is a rare but serious complication after a hemorrhoidectomy. This study analyzed the factors associated with secondary hemorrhage following a surgical hemorrhoidectomy.
METHODS
A total of 1,751 patients received a semiclosed hemorrhoidectomy for symptomatic hemorrhoidal disease from May 2001 to January 2004. A retrospective study of 17 patients with post-hemorrhoidectomy secondary hemorrhage was done. Fourteen patients (82 percent) underwent surgery primarily for hemorrhoidal disease, two patients (12 percent) had hemorrhoids removed in addition to a sphincterotomy for anal fissure, and the remaining patient (6 percent) had a hemorrhoidectomy with fistulectomy. The variables analyzed included age, gender, incidence, recurrence, hospitalization, bleeding tendency, blood transfusion, and management.
RESULTS
The male to female ratio was 1.83:1 (P>0.05), and the mean age was 38.9 (range 19~55) years. The incidence of post-hemorrhoidectomy secondary hemorrhage was 0.98 percent. The mean interval from the operation to hemorrhage was 8.9 (range 4~18) days. The period of mean hospitalization was 4.5 (range 2~8) days. As predisposing factors, 3 patients had suspected liver disease with normal platelet count. The mean 1.90 gm/dl of Hgb at the time of secondary hemorrhage was lower than the preoperative values. One patient (5.9 percent) required 3 units of red blood cell transfusions. Treatment modalities included observation alone in three patients (18 percent), and suture ligation in the operating theater in fourteen patients (82 percent). None of the patients developed recurrent bleeding.
CONCLUSIONS
Post-hemorrhoidectomy secondary hemorrhage is an inevitable and a troublesome complication. The patient will need to be transferred rapidly to a hospital and resuscitated if necessary. The author favors suture ligation in controlling secondary hemorrhage. Suture ligation offers a good outcome with virtually no risk of recurrent bleeding. Post- hemorrhoidectomy secondary hemorrhage usually occurs at home between the fourth and eighteenth postoperative day and takes place in 0.98 percent of hemorrhoidectomies. In the author's opinion, post-hemorrhoidectomy secondary hemorrhage usually is not a preventable complication.

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