He was treated as acute cystitis with ciprofloxacin 500 mg twice daily orally. Urinalysis showed leucocytes +2, WBC 40/HPF, and negative nitrates. His complete blood count and renal function tests were normal. His temperature was 38.2☌ and the rest of exam was unremarkable. The patient was stable during the procedure with minimal blood loss and was discharged to the postanesthesia recovery room.įive days after discharge, he came back to ER with fever, dysuria, frequency, and urgency for two days. No major complications were present during the procedure.Īs the patient weight was 114 kgm, height 172 cm, and BMI 38.5., the only difficulty encountered during surgery was in placing the anal dilator and fixing it in a correct position. Hemostasis was well secured with interrupted vicryl 3/0 sutures. Stapler device 33 mm Ethicon proximate (fixed anvil) stapler was then introduced and purse string snugly tied the Prolene suture ends were then retrieved through the device housing using the suture threader.ĭevice was closed by marking and then fired.Īn evenly excised mucosa was then retrieved, width of which is about 1.5 cm. Purse string anoscope was then used to place the purse string sutures on rectal submucosal level using Prolene 2/0, placing 5-6 bites at 4 cm distance from the anal verge. Procedure started by placing the anal dilator and fixing it with 2/0 silk interrupted sutures. Patient was placed in lithotomy posture.Įxamination under general anesthesia revealed second- and third-degree hemorrhoids. Surgery was done under spinal anesthesia and intravenous sedation. Indications for surgery were recurrent bleeding with second- and third-degree hemorrhoids. His past medical and surgical history were unremarkable apart from morbid obesity and recurrent urinary tract infections that required intravenous therapy in other hospital. Case PresentationĤ9-year-old Saudi male was operated on electively for second- and third-degree hemorrhoids after two ER visits with rectal blood spotting. Studies showed that SH has a significant higher rate of recurrence and postprocedural tenesmus. Ī retrospective study showed that septic complications after hemorrhoidectomy represent only 0.1% of all operated on patients (2840 patients). Sepsis, septic shock, and liver abscess have been also reported with other modalities of treating hemorrhoids as sclerotherapy and rubber band ligation. It can take up to 7 days to manifest clinically and a rare case of severe perineal sepsis has been reported after 38 days following SH. Sepsis following hemorrhoids treatment has been reported as early as 12 hours after therapy. Perineal necrosis, abscess, and septic shock have been also reported after SH. Retroperitoneal abscess and sepsis have been reported after SH stapled hemorrhoidopexy. Septic complications after treatment of hemorrhoids are extremely rare, but these can be devastating and have resulted in a number of deaths. This is an additional challenge for treating physicians as these organisms are sensitive only to one group of antibiotics (carbapenem group). In our electronic search, we could not find any case report of prostatic abscess after stapled hemorrhoidopexy caused by ESBL producing organism. Antibiotic was continued for 30 days and abscess resolved completely. pneumoniae could be detected only after aspiration of the prostatic abscess, but proper antibiotic was introduced intravenously on admission before culture of aspirate of the abscess was available. Our patient was a healthy middle aged Saudi male who has no significant medical history apart from morbid obesity and recurrent urinary tract infections. We are presenting a case report of a prostatic abscess caused by extended spectrum beta lactamase (ESBL) producing Klebsiella pneumoniae after hemorrhoidopexy. There are a good number of articles and case reports about these septic complications. Early diagnosis and prompt therapy are essential to save patient’s life. Postoperative septic complications of hemorrhoids surgical interventions are rare, but very serious with high mortality rate.
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