Post-hemorrhoidectomy Secondary Hemorrhage

PURPOSE: Post-hemorrhoidectomy secondary hemorrhage is a rare but serious complication after a hemorrhoidectomy. This study analyzed the factors associated with secondary hemorrhage following a surgical hemorrhoidectomy. METHODS: A total of 1,751 patients received a semiclosed hemorrhoidectomy for symptomatic hemorrhoidal disease from May 2001 to January 2004. A retrospective study of 17 patients with post-hemorrhoidectomy secondary hemorrhage was done. Fourteen patients (82 percent) underwent surgery primarily for hemorrhoidal disease, two patients (12 percent) had hemorrhoids removed in addition to a sphincterotomy for anal fissure, and the remaining patient (6 percent) had a hemorrhoidectomy with fistulectomy. The variables analyzed included age, gender, incidence, recurrence, hospitalization, bleeding tendency, blood transfusion, and management. RESULTS: The male to female ratio was 1.83:1 (P>0.05), and the mean age was 38.9 (range 19~55) years. The incidence of post-hemorrhoidectomy secondary hemorrhage was 0.98 percent. The mean interval from the operation to hemorrhage was 8.9 (range 4~18) days. The period of mean hospitalization was 4.5 (range 2~8) days. As predisposing factors, 3 patients had suspected liver disease with normal platelet count. The mean 1.90 gm/dl of Hgb at the time of secondary hemorrhage was lower than the preoperative values. One patient (5.9 percent) required 3 units of red blood cell transfusions. Treatment modalities included observation alone in three patients (18 percent), and suture ligation in the operating theater in fourteen patients (82 percent). None of the patients developed recurrent bleeding. CONCLUSIONS: Post-hemorrhoidectomy secondary hemorrhage is an inevitable and a troublesome complication. The patient will need to be transferred rapidly to a hospital and resuscitated if necessary. The author favors suture ligation in controlling secondary hemorrhage. Suture ligation offers a good outcome with virtually no risk of recurrent bleeding. Post- hemorrhoidectomy secondary hemorrhage usually occurs at home between the fourth and eighteenth postoperative day and takes place in 0.98 percent of hemorrhoidectomies. In the author's opinion, post-hemorrhoidectomy secondary hemorrhage usually is not a preventable complication.

A Clinical Study on Trauamtic Hyphema in Chunbuk area

A retrospective study was made of 334 consecutive cases of traumatic hyphema in the rural Chonbuk population. The average age of these patients was 26.2 years with the majority being male(91.9%). The major causes of traumatic hyphema were blow injuries(166 patients, 49.7%). The only 13 aptients(3.9%) had agriculture related injuries. Secondary hemorrhage occured in 23(6.9%) of all patient, and mainly between the second and fourth day following admission. A separate group of 88 patients(26.3%) who were admitted to hospital 24 hours or more after sustaining injury were found to have a secondary hemorrhage rate of 10.2%(nine of 88 patients). No secondary hemorrhage occured in Grade 0 hyphema. 22 eyes(6.5%) had a final visual acuity of 0.3 or worse. Retinal pathology,not hemorrhage, was most often responsible among those patients suffering poor visual outcome. In this study on the population of Chunbuk province, some patients were treated late, and had a high incidence of secondary hemorrhge.

The Management of Spontaneous Intracerebral Hemorrhage: Medical Versus Surgical Therapy for Spontaneous Intracerebral Hemorrhage

The results of treatment for 248 patients with spontaneous intracerebral hemorrhage are described. Spontaneous intracerebral hemorrhages are classified into primary(215 patients) and secondary(33 patients) hemorrhages. Most of the secondary hemorrhages were located in the subcortical area(64%). In the Non-treated group, eighty patients died immediately after diagnosis. In the treated group, the overall mortality was 5% in primary hemorrhages and 15% in secondary hemorrhages, and the percentages of hypertensive intracerebral hemorrhage patients returning to full-time work or independent life without disability or with minimal disability were 30% in putaminal hemorrhages, 86% in caudate hemorrhages, 44% in thalamic hemorrhages, 61% in subcortical hemorrhages, 78% in cerebellar hemorrhages and 40% in brainstem hemorrhages respectively. This study showed that surgical treatment did not give better result over conservative treatment in the management of hypertensive supratentorial and brainstem hemorrhage. However hypertensive caudate and cerebellar hemorrhage were associated with favorable outcomes regardless of the mode of therapy chosen. In severe hemorrhages, surgery may improve the length of survival, but the quality of life remains poor. The authors have shown again that aspiration surgery for hypertensive cerebellar hemorrhage is a valuable alternative to craniotomy.

Clinical Study of Traumatic Hyphema

We reviewed 114 patients who were admitted and treated at the Chonju Presbyterian Medical Center between 1986 and 1990 for nonperforating traumatic hyphema. Of these 114 cases, 103 (90.4%) were male and 11 (9.6%) were female. Mostly, they were under 20 years of age. Grade I hyphema (bleeding less than one third of anterior chamber) was 72 cases (63.2%). The causes of injuries were blows to the eye (56 cases, 49%) and projectile objects (45 cases, 39.5%). Associated injuries to the eye and periocualr structures occurred in 78 patients (68.4%), which were angle recession (23.7%), eyelid laceration (20.2%), increased intraocular pressure (16.7%), traumatic cataract (14.0%). Secondary hemorrhage occurred in 15 patients (13.2%) and was significantly more frequent among patients whose initial hyphema filled more than one therd of the anterior chamber. The final visual acuity were worse in eye with associated ocular injuries such as vitreo-retinal disorders, traumatic cataracts, etc.

Clinical Study of Traumatic Hyphema

We reviewed 114 patients who were admitted and treated at the Chonju Presbyterian Medical Center between 1986 and 1990 for nonperforating traumatic hyphema. Of these 114 cases, 103 (90.4%) were male and 11 (9.6%) were female. Mostly, they were under 20 years of age. Grade I hyphema (bleeding less than one third of anterior chamber) was 72 cases (63.2%). The causes of injuries were blows to the eye (56 cases, 49%) and projectile objects (45 cases, 39.5%). Associated injuries to the eye and periocualr structures occurred in 78 patients (68.4%), which were angle recession (23.7%), eyelid laceration (20.2%), increased intraocular pressure (16.7%), traumatic cataract (14.0%). Secondary hemorrhage occurred in 15 patients (13.2%) and was significantly more frequent among patients whose initial hyphema filled more than one therd of the anterior chamber. The final visual acuity were worse in eye with associated ocular injuries such as vitreo-retinal disorders, traumatic cataracts, etc.

Clinical Study of Traumatic Hyphema

Clinical study has been carried out on the 108 cases (108 eyes) of nonperforating traumatic hyphema who had been admitted to Kyungpook National University Hospital during the past five years. Male patients were 95(87.9%) of 108 and the third decade occupied about 40% of all cases. Grade I hyphema(less than one third of the height of the anterior chamber) was 66 cases(61.1%). Various projectiles accounted for nearly one third of the injuries. The most commonly associated ocular injuries included angle re cession, retinal edema, and eyelids laceration. Secondary hemorrhage occurred in 7.4% of all cases, and it seems that rebleeding increased the risk of secondary glaucoma. Although the final visual acuities were worse in eyes with larger hyphema and secondary hemorrhage, the associated ocular injuries such as vitreoretinal disorder, cataract, etc. accounted for the decreased visual acuity.