Worst case of hemorrhoidal prolapse ever & PPH
BEWARE! Gory image
A 45 year old male with history of chronic reducible hemorrhoidal disease came to the emergency department with excruciating pain, rectal bleeding and an anal non-redicible mass after a bowel movement.
On examination, we found this:
In this case, the only way to reduce the prolapse is a procedure for prolapsing hemorrhoids (PPH) which is an innovative approach to the management of enlarged, prolapsing hemorrhoids. Rather than rely on excision of the complexes, the primary goal is to reduce the hemorrhoidal tissue and anoderm to the correct anatomical location within the anal canal. It is important to keep this goal in mind, because the misinterpretation of anodermal migration externally as external hemorrhoids leads to unnecessary excision of sensate skin during PPH. In fact, with a correctly performed procedure, the relocated anoderm will shrink over time.
For this, we need an hemorroidal circular stapler kit which includes: clear plastic anoscope, half-slit anoscope, suture threader, and the 33 mm stapler.
Here is an animation video of how the procedure works, and how does the anal canal looks like before and after the procedure.
Regards,
Jon Mikel Iñarritu, M.D.
More information of hemorrhoidal disease in this site is here:
Thrombosed Hemorrhoid
Sid Schwab
Wednesday, 26th July 2006 at 3:35 pm
Nice post. I’ve always thought hemorrhoidal disease is among the most misunderstood by primary care docs. Some is just a matter of terminology (perianal hematoma vs thrombosed hemorrhoid, for example). Managing 4th degree prolapse can be a real mess, and this stapling technique seems to be becoming a very useful step forward.
JonMikel, M.D.
Wednesday, 26th July 2006 at 4:31 pm
I agree with doctor Schwab. Hemorrhoidal disease and/or rectal diseases are hidden sciences for most primary care doctors and much more for lay people.
I’ll try to explain this diseases from clinical cases.
Thanks for your comment. I hope to see you around here more often.
hoping4more
Friday, 4th August 2006 at 4:04 pm
wow…what could cause this severe case of hemorrhoidal prolapse? I am glad you know how to treat it! that looked excruciating, yikes! ugh, i can’t see how it got to this point (without treatment?) (but i’m not educated about it).
JonMikel, M.D.
Friday, 4th August 2006 at 5:57 pm
hoping4more:
Non treated hemorrhoidal disease, straining, constipation, diarrhea, prolonged sitting and pregnancy, are the causes of hemorrhoidal prolapse.
It is very common in people to have hemorrhoidal disease, but frequently it is succesfull treated with conservative measures; when people choose not to treat the condition perpetuates and complicates.
Thank you for your comment.
Tham (Malaysia)
Monday, 12th March 2007 at 11:55 am
I had a combined stapled plus diatherm hemorrhoidectomy
three years ago. The stapled procedure resulted in fecal
urgency, at least 5 times a day, for about a month - just as
reported in several studies in Medline. The was also stenosis,
and muscle spasms, due to the suture tugging on the anoderm,
I believe. This lasted some two months, during which I was
in considerable discomfort.
It also resulted in fecal impaction two times over a period of
about two months, which has also been reported in Medline
with this stapled method.
It seems one of them, which I think was the biggest one
which had to be excised with diathermy, has recurred
just after two years as Stage 2.
The diathermy procedure was accompanied be heavy
postoperative blood loss and extreme pain. Pethidine
relieved the pain for barely an hour the first night.
I should have chosed the harmonic scalpel, as noted in
Medline studies, which found no advantage of the PPH
method over it. The PPH device wasn’t cheap either, costing
some M$1,500.
If I had selected the harmonic scalpel, I wouldn’t have
experienced blood loss from the one hemorrhoid which
could not be pulled up by the PPH and had to be cut off
by diathermy. Postoperative pain would also have be
very likely much reduced.
I’ll make sure I choose the harmonic scalpel, or at least
the laser, if I need surgery again.
Marcos Hurvitz
Wednesday, 23rd May 2007 at 8:40 am
I would like to receive the video of PPH procedure.
Thanks
Best wishes
Goe tse, MD
Monday, 28th May 2007 at 12:29 pm
rectum? damn near killed him.
Shively
Monday, 28th May 2007 at 12:35 pm
I would be interested in learning if this man was homosexual and if so, was this caused by homosexual behaviors over a peroid of say 6 months to a year>?
Entensity Fan
Wednesday, 30th May 2007 at 4:44 pm
Where i’m from, we call that Goatse. You see, the man CLAIMED he had hemorrhoidal prolapse, but he just needs to keep his fist out of his butt. This is also comonly called a rose bud.
jeffrey
Sunday, 12th August 2007 at 9:28 pm
thanks for the reply.
i am not a doctor yet though. :) long way to go.
Joe
Sunday, 11th April 2010 at 9:42 pm
Shively: I’m not a doctor. But I can say for sure that anal sex in no way contributed to this guy’s condition in any way. As far as I’m aware, most gay men can sit and pass stool comfortably.