Rectal perforation as a result of stapled hemorrhoidectomy

Background: The procedure for prolapsing hemorrhoids (PPH) has the potential to overcome many of the disadvantages of excisional hemorrhoidectomy; nevertheless, rare serious postoperative complications have been reported. Clinical case: We present a case of a 31-year-old male who was admitted and treated at another hospital with a stapled mucosectomy, which was carried out using a PPH01 33-mm stapling device. During the immediate postoperative period a fistula presented from the rectum to the right gluteus and a primary closure was attempted. However, the patient continued with the same symptoms and was referred to our hospital in October 2009. On examination at our Department of Colorectal Surgery, a right gluteus abscess was found and a primary orifice in the rectum with a diameter of 10 mm at 4 cm from the anal verge, confirmed with magnetic resonance imaging. A primary closure was attempted; however, during follow-up the patient presented edema, erythema and induration of the right gluteus and a failed closure of the fistula. An endorectal advancement flap was successful in the closure of the fistula. Conclusions: Complications with PPH may compromise function or may be life threatening for the patient, requiring further surgeries with increased morbidity and mortality. Therefore, it is recommended to be performed by surgeons with special training in this procedure.