Leczenie olbrzymich, zakrzepowo zmienionych hemoroidów – opis przypadku

© Borgis - Nowa Medycyna 2/2015, s. 55-58 | DOI: 10.5604/17312485.1167038

*Konrad Kobryń¹, Małgorzata Kołodziejczak², Krzysztof Zieniewicz¹, Tadeusz Wróblewski¹

Summary
Hemorrhoid thrombosis is a rare but dangerous complication of hemorrhoid disease. The main symptom of the disease, causing patients to go to hospital is severe pain. This is caused by hypertonicity of the internal sphincter. The pain itself is expressed during sitting and defecating. Our report describes the case of 64-year-old patient admitted to the emergency room due to external thrombosed gangrenous hemorrhoids. He presented inability to defecate due to excessive pain, mild abdominal pain, discomfort and irritation withholding him from walking and sitting. In his medical records, only arterial hypertension was noted and treated pharmacologically for the last ten years. The patient previously was treated for 5 years in a non-operative manner, this included diet, sitz-baths, suppositories and banding of hemorrhoids in the outpatient room.
Following a short preoperative work up, the patient was qualified for emergent surgery. He received antibiotic therapy (amoxicillin with clavulanate potassium 1,2 g x 3 daily) and antithrombotic prophylaxis (nadroparine 0,4 ml x 1 daily s.c.). A Milligan-Morgan open procedure was performed as method of choice. The hemorrhoids were dissected from the sphincter mechanism and all were resected. All three quadrants were excised identically. Pedicles were then ligated, thus hemostasis was satisfactory. The course of surgery was uneventful, the wound healed without swelling, pain subsided and the patient was discharged on the 3rd post-operative day in good general condition.
Conclusions: Patients with thrombosis hemorrhoids should be operated on as soon as possible because of threatening septic complications, including Fournier gangrene. Antibiotic treatment and prophylaxis is necessary. Surgical treatment of patients with thrombosed hemorrhoids results in prompt and good therapeutic outcome.