Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 6, 2022; 10(19): 6656-6663
Published online Jul 6, 2022. doi: 10.12998/wjcc.v10.i19.6656
Massive gastrointestinal bleeding after endoscopic rubber band ligation of internal hemorrhoids: A case report
Yu-Dong Jiang, Ying Liu, Jian-Di Wu, Gang-Ping Li, Jun Liu, Xiao-Hua Hou, Jun Song
Yu-Dong Jiang, Ying Liu, Jian-Di Wu, Gang-Ping Li, Jun Liu, Xiao-Hua Hou, Jun Song, Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
Author contributions: Jiang YD reviewed the literature and contributed to the manuscript drafting; Liu Y and Wu JD were the patient’s primary doctors; Li GP collected the data; Liu J and Hou XH substantially contributed to the data analysis and literature review; Song J performed the therapy and was responsible for the revision of the manuscript.
Informed consent statement: Informed written consent was obtained from the patient prior to the study, agreeing for publication of this report and accompanying material.
Conflict-of-interest statement: All authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jun Song, MD, Chief Physician, Professor, Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Road, Wuhan 430022, Hubei Province, China. song111jun@126.com
Received: December 20, 2021
Peer-review started: December 20, 2021
First decision: March 10, 2022
Revised: March 23, 2022
Accepted: May 12, 2022
Article in press: May 12, 2022
Published online: July 6, 2022
Abstract
BACKGROUND

Rubber band ligation (RBL) using rigid anoscope is a commonly recommended therapy for grade I-III symptomatic internal hemorrhoids. Severe complications of RBL include pain, hemorrhage and sepsis. Flexible endoscopic RBL (ERBL) is now more commonly used in RBL therapy but few severe complications have been reported. Here we report on a case of massive bleeding after ERBL.

CASE SUMMARY

A 31-year-old female was admitted to the department of gastroenterology with a chief complaint of discontinuous hematochezia for 2 years. No previous history, accompanying diseases or drug use was reported. Physical examination and colonoscopy showed grade II internal hemorrhoids. The patient received ERBL therapy. Five days after ligation, the patient presented with mild hematochezia. On days 7 and 9 after ligation, she presented with a large amount of rectal bleeding, dizziness and weakness. Emergency colonoscopy revealed active bleeding and an ulcer in the anal wound. The patient received two sessions of hemoclipping on days 7 and 9 to treat the bleeding. No further bleeding was reported up to day 15 and she was discharged home. Although the hemorrhoid prolapse disappeared after ERBL, she was dissatisfied with the subsequent complications.

CONCLUSION

ERBL therapy is an effective treatment for symptomatic internal hemorrhoids with satisfactory short and long-term recovery. Pain and anal bleeding are the most frequently reported postoperative complications. Coagulation disorders complicate the increased risk of bleeding. Although rarely reported, our case reminds us that those patients without coagulation disorders are also at risk of massive life-threatening bleeding and need strict follow-up after ligation.

Keywords: Internal hemorrhoids, Endoscopy, Rubber band ligation, Complication, Bleeding, Case report

Core Tip: Endoscopic rubber band ligation (ERBL) is an effective treatment for symptomatic internal hemorrhoids and few severe complications have been found. A 31-year-old female with grade II internal hemorrhoids received ERBL therapy. No previous history or coagulation disorder was reported. Meanwhile, she presented with delayed massive rectal bleeding after the ligation. Colonoscopy showed active bleeding and ulcers in the anal wound. Coagulation disorders were previously reported in relation to bleeding after ligation. However, this case reminds us that patients without coagulation disorders are also at risk for massive life-threatening bleeding after ERBL.