A Study of Flexible Sigmoidcolonoscopy of Outpatients who Presented with Anal Bleeding

*** Anal lesion caused by human papillomavirus in a woman living with HIV/AIDS ***AIMS: To describe a case of anal lesion caused by human papillomavirus (HPV) infection in a woman living with HIV/AIDS.CASE DESCRIPTION: A 35-year-old woman, diagnosed with HIV five years ago, reported pruritus ani, anal bleeding, painful defecation, and presence of small warts in the perianal region. The patient was seen at a specialized care center and was subjected to clinical examination with visual inspection, which revealed perianal condyloma. Histopathological examination confirmed the presence of moderate to severe dysplasia associated with HPV-compatible changes. The anal lesion was excised. At the onset of the symptoms, the patient was not on antiretroviral therapy and her HIV viral load was at its highest (2,951 copies/mL) compared with her previous laboratory tests. She had gone through emotional stress and presented with recurrent genital herpes simplex virus infections. These factors may have predisposed her to the development of anal condyloma.CONCLUSIONS: Since HIV infection may alter the history of HPV infection, it is important that screening strategies include cytological analysis of both the cervix and the anal region.

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Anorectal diseases in patients with Antiphospholipid syndrome: a cross-sectional study

Advances in Rheumatology ◽

10.1186/s42358-020-00153-5 ◽

2020 ◽

Vol 60 (1) ◽

Author(s):

E. Cunha ◽

V. Guzela ◽

G. G. M. Balbi ◽

C. Sobrado ◽

D. Andrade

Keyword(s):

Surgical Treatment ◽

Antiphospholipid Syndrome ◽

Clinical Manifestations ◽

Warfarin Dose ◽

The United States ◽

Bivariate Analysis ◽

Cross Sectional ◽

Significance Level ◽

Anal Bleeding ◽

Internal Hemorrhoids

Abstract Background Hemorrhoid disease (HD) is one of the most common gastrointestinal complaints worldwide, affecting 4.4% of the general population in the United States. Since antiphospholipid syndrome (APS) may lead to intra-abdominal thrombosis, one may expect that this condition can impact the risk for HD development. Additionally, as APS patients are more prone to thrombosis and treatment with anticoagulants may increase risk of bleeding, one may also infer that rates of HD complications may be higher in this scenario. Nevertheless, no data in these regards have been published until now. The objective of the present study is to evaluate frequency of HD and describe its complications rates in antiphospholipid syndrome APS patients. Methods We consecutively invited patients who fulfilled APS criteria to undergo proctological examination. After examination, patients were divided in two groups, based on the presence of HD, and compared regarding different clinical manifestations and antiphospholipid profile. We performed the analysis of the data, using chi-square and Mann Whitney U when applicable and considering a significance level of 0.05. Multivariate regression analysis included age and variables with p < 0.10 in the bivariate analysis. Results Forty-one APS patients agreed to undergo proctological examination. All were female and overall median age was 43 (36–49). Seventeen (41.4%) patients were diagnosed with HD, with the following frequency distribution: 7 internal (41.2%), 4 external (23.5%) and 5 mixed hemorrhoids (29.4%). Of the internal hemorrhoids, 5 patients were classified as grade I (71.4%), 1 grade II (14.3%), and 1 grade IV (14.3%). Prior gestation (p = 0.067) and constipation (p = 0.067) correlated with a higher frequency of HD. In multivariate analysis, constipation remained as an important risk factor (OR 3.92,CI95% 1.03–14.2,p = 0.037). Five out of 17 patients (29.4%) reported anal bleeding, but it did not correlate with warfarin dose (p = 0.949). Surgical treatment was indicated for 10 patients (58.8%). Other anorectal findings were anal fissure, plicoma, condyloma and one chlamydial retitis. Conclusion We found an unexpected high frequency of hemorrhoids in APS patients, with a great proportion requiring surgical treatment.

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Haemorrhoidal artery ligation with and without Doppler guidance in the treatment of haemorrhoidal disease: a single-centre randomized study

Sechenov Medical Journal ◽

10.47093/2218-7332.2021.274.01 ◽

2021 ◽

Author(s):

P. V. Tsarkov ◽

M. A. Popovtsev ◽

Yu. S. Medkova ◽

A. V. Alekberzade ◽

N. N. Krylov

Keyword(s):

Patient Satisfaction ◽

Clinical Symptoms ◽

Control Group ◽

Controlled Clinical Trial ◽

Study Group ◽

Treatment Results ◽

Artery Ligation ◽

Haemorrhoidal Disease ◽

Anal Bleeding

Aim. To evaluate the efficacy of haemorrhoidal artery ligation (HA) with a preliminary palpatory determination of its localization supplemented by mucopexy of haemorrhoids as a new surgical method in the treatment of haemorrhoidal disease (HD) and to compare it with HAL-RAR technology.Materials and methods. The randomized controlled clinical trial included patients over 18 years old with Goligher’s grade II, III or IV symptomatic HD. We operated on patients in the study group (n = 75) using palpatory determination of the localization of HA and subsequent mucopexia. In the control group (n = 75) we used HAL-RAR. The primary endpoint (25–30 days after surgery): recurrence rate of HD symptoms. Secondary endpoints: postoperative complication rate, pain intensity on a visual-analogue scale from 1 to 10 points, patient satisfaction with the treatment results on a 10-point scale.Results. According to the initial characteristics (age, gender, body mass index, stage of HD, frequency of clinical symptoms), the groups did not differ. Anal bleeding relapse developed: study group – 11%, control group –14%; relapse of haemorrhoids prolapse: 3% and 5% respectively (p > 0.05). Postoperative complications were noted in 6 (8%) in the study group and 4 (5%) in the control group (p > 0.05). The intensity of pain on the 2nd and 25–30 days after surgery was 6.3 [4.8; 7.4] and 1.2 [0.6; 2.5] points in the study group and 6.5 [4.9; 7.3] and 2.1 [1.9; 4.1] in the control group, respectively (p > 0.05). Patient satisfaction with the treatment results after 12 months was estimated at 8.7 [7.9; 9.2] and 9.4 [8.2; 9.6] in the study and control groups, respectively (p > 0.05).Conclusion. HA ligation with a preliminary palpatory determination of its localization and supplemented with mucopexy of haemorrhoids is no less effective than HAL-RAR in preventing haemorrhoidal bleeding and prolapse of the nodes.

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A Case of Neuroendocrine Cell Carcinoma of the Jejunum Presented with Anal Bleeding.

Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) ◽

10.3919/jjsa.63.2710 ◽

2002 ◽

Vol 63 (11) ◽

pp. 2710-2714 ◽

Cited By ~ 1

Author(s):

Katsumi TAIRA ◽

Tomomi CHIBANA ◽

Katsumasa SHIMOJI ◽

Yasushi OMINE ◽

Isao YARA

Keyword(s):

Cell Carcinoma ◽

Neuroendocrine Cell ◽

Anal Bleeding

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Initial experience with stapled hemorrhoidopexy for treatment of hemorrhoids

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032006000300016 ◽

2006 ◽

Vol 43 (3) ◽

pp. 238-242 ◽

Cited By ~ 14

Author(s):

Carlos Walter Sobrado ◽

Guilherme Cutait de Castro Cotti ◽

Fabricio Ferreira Coelho ◽

Júlio Rafael Mariano da Rocha

Keyword(s):

Pain Control ◽

Radical Change ◽

Stapled Hemorrhoidopexy ◽

Anal Stenosis ◽

Initial Experience ◽

Safe Alternative ◽

Rescue Analgesia ◽

Fourth Degree ◽

Conventional Hemorrhoidectomy ◽

Anal Bleeding

BACKGROUND: Introduction of stapled hemorrhoidopexy by Longo in 1998 represented a radical change in the treatment of hemorrhoids. By avoiding multiple excisions and suture lines in the perianal region, stapled hemorrhoidopexy is intended to offer less postoperative pain than with conventional techniques. OBJECTIVE: To report and analyze the intra and postoperative results gained during initial experience with stapled hemorrhoidopexy. METHODS: One hundred and fifty five patients (67 males) with average age of 39.5 years (21-67 years) underwent stapled hemorrhoidopexy between June 2000 and December 2003 with symptomatic third-degree (n = 74) and fourth-degree (n = 81) hemorrhoids. Mean follow-up period was 20 months (14-60 months). RESULTS: Preoperative symptoms were prolapse (96.7%) and anal bleeding (96.1%). Overall mean operative time was 23 minutes (16-48 minutes). We observed one case of stapler failure and one case of failure to introduce the stapler occurred in a patient with previous anal surgery. Additional sutures for hemostasis were required in 103 patients (66.5%). Resection of skin tags was performed in 45 cases (29%). Postoperatively scheduled analgesia with oral dipyrone and celecoxib was enough for pain control in 131 patients (84.5%). Rescue analgesia was necessary in 24 cases (15.5%). Five patients needed opiates for pain control. Hospital discharge took place on the first postoperative day in 140 patients (90.3%). First defecation without pain was reported by 118 patients (76.1%). Postoperative complications were anal bleeding (10.3%), severe pain (3.2%), urinary retention (3.9%), fever without any signs of perianal infection (1.9%), incontinence for flatus (1.9%), hemorrhoidal thrombosis (1.3%). Two patients presented symptoms of recurrent hemorrhoidal disease and were successfully treated by conventional hemorrhoidectomy. They were no cases of anal stenosis, permanent incontinence, chronic pain or deaths in this series. CONCLUSIONS: Hemorrhoidopexy can be considered a feasible and safe alternative technique to conventional hemorroidectomy for select patients.

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Anal bleeding survey

The Lancet ◽

10.1016/s0140-6736(94)92241-1 ◽

1994 ◽

Vol 344 (8924) ◽

pp. 751-752 ◽

Cited By ~ 6

Author(s):

S.M. Farquharson ◽

R.J. Heald

Keyword(s):

Anal Bleeding

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An unusual haemorrhagic complication of an anastomotic leak and a novel method of controlling the haemorrhage

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2016.0321 ◽

2017 ◽

Vol 99 (3) ◽

pp. e116-e119 ◽

Cited By ~ 3

Author(s):

S Martin ◽

A Armstrong

Keyword(s):

Anastomotic Leak ◽

Loop Ileostomy ◽

Prolonged Release ◽

Foreign Object ◽

Haemorrhagic Complication ◽

Ileostomy Reversal ◽

Anal Bleeding ◽

History Of ◽

Novel Method ◽

Cook Medical

Introduction Restorative proctocolectomy (RP) is undertaken for patients with familial adenomatous polyposis (FAP) and ulcerative colitis, but is associated with a risk of anastomotic leak. Case history A 20-year-old male with a family history of FAP had a RP with a double-stapled J-pouch and covering loop ileostomy. At ileostomy reversal 21 months later, he presented with significant anal bleeding. He proceeded to theatre for endoscopy. Pouchoscopy showed a pouch full of blood and a foreign object trapped in a diverticulum. The foreign object (an undigested tablet) was removed with grasping forceps and the bleeding spot identified. Hemospray® (Cook Medical, Winston-Salem, NC, USA) was deployed in the bleeding cavity to enable immediate control of haemorrhage. Recovery was uneventful and he was discharged home 72 hours later. Conclusions This case: (i) demonstrates a successful and novel method of controlling haemorrhage not amenable to use of conventional haemostatic mechanisms; (ii) highlights the potential problems of using prolonged-release medications in patients with gastrointestinal strictures/diverticulae.

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