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:
hemorrhoidal prolapse

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.


Jon Mikel Iñarritu, M.D.

More information of hemorrhoidal disease in this site is here:
Thrombosed Hemorrhoid

20 thoughts on “Worst case of hemorrhoidal prolapse ever & PPH”

  1. Can I ask you guys a personal question?…

    What do you think of the rectum as a whole (or is that hole)?

    HaHa, please don’t take offense to my lil joke. I found this site because I am dealing with a roid that I’ve had for over 2 weeks now and am starting to wonder if it is something else. I’m kinda freaked out. I have pain in to my groin and left testicle and have been too embarrassed to go to a doctor. I don’t even have a PCP because I haven’t needed to see a doc in years as I am 33 and in good health overall.

  2. My husband has been in severe pain,loosing 50lbs. since Dec 2011 due to hemrroids.He had an upper and lower GI done in May and his Dr. said it wasn’t bad enough to do surgery.He has severe pain that goes down is left leg after a bowel movement,this last for quiet some time.He is on medical leave as of right now…We need HELP!
    Loving wife

  3. My case was worse. There are three major areas (veins) that can prolapse. I work in a seniors home, where heavy lifting and resistance to being lifted are frequent. Imagine a hernia, but it going the other way. I am having surgery tomorrow to try and correct the problem. I am not a homosexual nor have I ever had anything inserted into my rectum. I would never wish a re-insertion upon an enemy. The surgery has been described as being “horrific”. I will expect 1 week of healing and 1 of slow, careful exercise. I WILL RETURN TO WORK.

  4. Mich,

    I see no reason for your comment. It seemed to be one made purely to ‘troll’ Joe. Anal sex is not necessarily an unsafe practice as long as you take care not to damage your anal cavity in any way. It is only unsafe when having unclean and/or sex with someone who has a STD.

    The facts that we know about the PPH patient is that he is a white male, age 45, and has a history with history of chronic reducible hemorrhoidal disease. We do not know his height, weight, sexual orientation, or anything else. And, even if the man was gay, it is clear that this was not caused by having anal sex. This was caused by not having treated hemorrhoidal disease, straining, constipation, diarrhea, or prolonged sitting, Without actually either getting our hands on his case file or asking him, we will never find out.

    On a different note; this treatment seems like a suitable one depending on person and/or how bad the prolapse is. However, Tham, an above commentor, seems to have had the procedure and met with unsatisfactory results. I am not certain as to why, I’m actually a Cardiologist and researcher, and have never dealt with patients who have hemorroidal disease. Though, as I said, it seems to differentiate from person to person. However, I would say this article would be very helpful to scaring someone into taking better care of their body, that’s for sure! And, of course, taking better care of their hemorroids. But it’s also helpful if one were to be researching options to deal with their own or to find out if they themselves have prolapse.

    4.5 stars from me.

  5. Joe’s comment makes not sense. He gives no support for his “for sure” assertion. I’m guessing he may be gay and wants to believe anal sex is safe — well, Joe, it actually is very UNsafe. (This is what Joe asserted w/o any backing: “I can say for sure that anal sex in no way contributed to this guy’s condition in any way. As fare as I’m aware, most gay men can sit and pass stool comfortably.”)

  6. Christ that must have hurt. I struggle with soreness to the point of desperation and I am not gay, do not have piles, I look after my self, exercise, eat well and do not push jam jars up my ass. But I can sympathise with Mr Prolapse over there.

  7. 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.

  8. 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.

  9. 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>?

  10. 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.

  11. 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.

  12. 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).

  13. 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.

  14. 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.

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