The diagnostic value of squirting rectal bleeding: The first description of such bleeding pattern

Background and objective: Rectal bleeding is a common symptom that has many patterns, but none of them are accurately diagnostic. One newly noticed pattern can be diagnostic, namely, the squirting pattern, for which this study was conducted. Methods: The study was conducted between Jan 2013 and Jun 2018, including 132 patients who presented with a squirting pattern of rectal bleeding, which is thought to be due to hemorrhoids. All these patients underwent clinical evaluation and anoscopy, and the majority (n=94) underwent colonoscopy. Results: At the time of clinical examination, 23 patients showed actively bleeding hemorrhoids. Fifteen patients were not convinced to undergo colonoscopy. The rest (n=94) who had no visible active bleeding at the time of examination underwent a colonoscopy to exclude other possible rectal or colonic pathology. All the 94 colonoscopies were negative for other bleeding sources. Two patients showed single benign non bleeding polyps, which were excised and biopsied. Conclusion: This study highlights a pattern of rectal bleeding that is not described before and proved it is a reliable diagnostic pattern for hemorrhoids. It also showed that colonoscopy is not needed in patients below 40 years complaining of squirting rectal bleeding unless indicated for some other reason. This decision is to be made very carefully. Keywords: Squirting rectal bleeding; Hemorrhoids; Colonoscopy.

THE EFFECT OF LEHA KAMALA IN THE MANAGEMENT OF BAHUPITTA KAMALA A CASE STUDY

Kamala is described under Raktavaha Srotas & Yakrit-pliha is the mula sthan of Raktavaha Srotas. Acharya Charaka said that Kamala is next stage of pandu mainly cause due to frequently consumption of Ushna (hot), Tikshna (spicy) food i.e. Pittaprakopak Ahara (increasing level of Pitta) but Sushruta and Vagbhata have accepted Kamala (Jaundice) not only as one of the complications of Pandu Roga (Aneamia) but also in association of other diseases. Due to these factors vitiation of Pitta (bile), Rakta (blood) and Mamsa (muscles) Dhatu occurs. Symptoms like yellowish discoloration of skin (Twak pitata), sclera (netra pitata), urine (Mutra pitata), stool (Purisha pitata) etc. are clinical symptoms of Kamala. Ayurveda believes in treating disease at its root cause from within. The present article is a case report of 56 years old male, farmer by profession visited in OPD and then admitted in IPD of Dr. M.N. Agashe Dharmarth Rugnalalaya, Satara on 07/12/2020 having complaining of Netra pitata (icterus), Mutrapitata (Yellowish urine), Adhmana (pain in abdomen), Sakashta mutrapravrutti (painful micturition), Padashotha (Bipedal edema), Mukhapaka (Mouth ulcer) from last 4 days. He was on antihypertensive drug regularly. He was having Arsha (bleeding hemorrhoids), also having h/o Kamala 2 years ago. The patient was treated with Ayurveda management under IPD and then OPD basis for 3 weeks. This helps to achieve complete curative and prophylactic management of Bahupitta Kamala through Ayurveda.

Emergency treatment of bleeding hemorrhoids in a patient taking aspirin and clopidogrel using a 1470 nm diode laser and the ELITE minimal invasive technique

A 74-year-old male patient, receiving anticoagulation treatment after previous angioplasty stenting for severe coronary artery disease, was admitted to the clinic with a 2-day rectal bleeding. Clinical examination followed by an urgent colonoscopy to exclude other potential reasons for his symptoms both confirmed the diagnosis of Grade III thrombosed hemorrhoids. Due to the acute presentation of the case along with the existing medication of the patient, the decision was made to treat the problem using the expert laser intrahemorrhoidal therapy technique, which is a diode laser minimally invasive operation without the need to stop any of the patient’s medication.

Efficacy of foam sclerotherapy in treatment of grade I and grade II bleeding hemorrhoids at Nalanda Medical College and Hospital, Patna

Background: Sclerotherapy is the treatment of choice for first and second grade haemorrhoidal disease. The aim of this study is to assess the efficacy and safety of polidocanol foam for haemorrhoidal disease.Methods: A total of 50 patients were treated with foam sclerotherapy (polidocanol 3%). Patients who presented with complain of bleeding per anum and diagnosed with first and second grade hemorrhoidal disease were included. Patients without bleeding per anum were not included. The primary objective was the stopping of perianal bleeding after one sclerotherapy session. Sclerotherapy was repeated at 2-week intervals until patients were free of bleeding. The final follow-up was 12 weeks after the last sclerotherapy session.Results: After one foam sclerotherapy session, 82% of patients (41 out of 50) were treated successfully. After second sclerotherapy, 98% of the patients (46 out of 50) were treated successfully. 2% of the patients received third sclerotherapy.Conclusions: In the treatment of first and second grade haemorrhoidal disease, polidocanol 3% foam is very effective and safe. The results of this study show that foam sclerotherapy is a new, innovative, effective and safe non-surgical treatment option for haemorrhoidal disease.

Do We Have Another Option to Treat Bleeding Hemorrhoids? The Emborrhoid Technique: Experience in 16 Patients

Background: Hemorrhoidal disease is very common in western countries and rectal bleeding is the main symptom complained by patients. Nowadays the ultimate goal of treatment is to block the bleeding with minimally-invasive techniques to minimize post-procedural pain. Objective: The aim of this study is to assess the preliminary results of the emborrhoid technique (embolization of the superior rectal arteries branches) as a new tool for the proctologist to treat severe bleeding hemorrhoids causing anemia. Many categories of patients might benefit from this treatment, such as patients not eligible for conventional surgery, patients not responding to conventional treatment and fit patients with severe bleeding who refused endorectal surgical therapy. Method: From May 2017 to November 2018 a total of 16 patients with chronic rectal bleeding due to hemorrhoids underwent super-selective embolization of the superior rectal arteries at the department of General Surgery in La Spezia, S. Andrea Hospital, Italy. Median age was 59 years. 14 patients were males (87.5 %). Results: No post-procedural and short-term complications were observed at maximum follow up (12 months). The reduction of rectal bleeding with improvement of the quality of life was obtained in 14 patients (87.5%). Conclusion: Our study, although small in number, demonstrates that embolization of superior rectal arteries with coils to treat severe bleeding due to hemorrhoids is safe and effective and does not lead to immediate complications.

STANDARDIZATION AND COMPARATIVE ANALYSIS OF DIFFERENT MARKETED FORMULATION OF AGNIMUKH CHURNA

The subject of herbal drug standardization is massively wide and deep, there is so much to know and so much seemingly contradictory theories on the subject of herbal medicine and its relationship with human physiology and mental function. India needs to explore the important formulations in the classical ayurvedic texts. This can be achieved only if the herbal products are evaluated and analysed using sophisticated modern techniques of standardization such as UV-Visible, TLC, HPLC, HPTLC, etc. The present paper reports on Standardization and Comparative Analysis of Different Marketed Formulation of Agnimukh Churna, a poly herbal ayurvedic medicine used in treatment of anorexia, indigestion, constipation, spleen disorders, non bleeding hemorrhoids’ and abdominal pain. Agnimukh Churna was prepared as per Ayurvedic text of Yogaratnakara, India. In-house preparation and two marketed have been standardized on the basis of organoleptic characters, physical characteristics, physico-chemical properties, TLC and HPLC for the estimation of marker compound Piperine. The set parameters were found to be sufficient to evaluate the Churna and can be used as reference standards for the quality control/quality assurance laboratory of a Pharmaceutical house. Keywords: Agnimukh Churna; Physicochemical parameters; organoleptic characters; Polyherbal formulation; Standardization; Piperine

Day care management of grade I and II bleeding hemorrhoids

Background: Hemorrhoids occur in up to 80% of the population, involving any age and affecting males and females equally1 First and second-degree hemorrhoids can be treated conveniently on an out-patient basis by sclerotherapy and rubber band ligation 2. This study aims at comparing outcomes of these modalities for the treatment of grade I and II bleeding hemorrhoids.Methods: In NKP Salve institute of Medical Sciences and Research Centre hospital based nonrandomized comparative study, patients clinically diagnosed as Grade I and II bleeding hemorrhoids were included. Subjects were divided in into two groups i.e Barron’s banding and Injection of Sclerosant. The post procedural complications for the first 24 hrs were recorded, follow up was taken at regular intervals and any complications were recorded.Results: A total of 50 patients were enrolled with mean age 42.01 years and a male preponderance, with 31 males and 19 females. Barron’s banding was carried out in 25 subjects and the 25 subjects were subjected to Injection of sclerosant the mean duration taken for Injection of sclerosant was 13.6 min and in Barron’s banding 16.4 min. In the first 24hrs post procedural bleeding was observed in 40% subjects in the Barron’s banding group and 52% in the injection of sclerosant group. For post procedural pain the mean VAS score in the Barron’s group was 1.84 and 0.96 in injection of sclerosant group, follow up at 3rd month showed 16% recurrence of bleeding and 32% in injection of sclerosant group.Conclusions: Injection of sclerosant is better than Barron’s banding procedure in terms of post procedural pain.