Case Report on Strangulated Grade IV Hemorrhoidal Disease in a 28-Year-Old Male
1 Emergency and trauma unit, St. Martins Catholic Hospital, Agroyesum, Amansie South District, Ashanti Region, Ghana.
2 Department of Emergency and Trauma, Our Lady of Fatima Catholic Hospital, Bwari, Abuja, Nigeria.
World Journal of Advanced Research and Reviews, 2022, 16(01), 1270-1272
Publication history:
Received on 13 September 2022; revised on 23 October 2022; accepted on 28 October 2022
Abstract:
Introduction: Strangulated hemorrhoidal disease represents one of the most painful and urgent anorectal emergencies. It occurs when prolapsed internal hemorrhoids become incarcerated and their venous return is compromised, leading to edema, ischemia, and potential necrosis. Prompt diagnosis and surgical management are critical to preventing systemic complications such as sepsis.
Case Presentation: We report a case of a 28-year-old male who presented to the emergency department with a painful irreducible hemorrhoidal prolapse of two days’ duration. The patient had a two-year history of recurrent prolapse during defecation, which usually reduced spontaneously. However, the most recent episode failed to retract, and subsequent self-treatment with herbal preparations resulted in worsening pain and inflammation. Examination revealed a tender, edematous, prolapsed hemorrhoidal mass with minimal abrasions. The patient was febrile and tachycardic but normotensive and maintaining normal oxygen saturation.
Management: The patient was promptly stabilized, started on intravenous fluids, broad-spectrum antibiotics, and analgesics. The prolapsed hemorrhoidal tissue was covered with moist sterile gauze while preparations were made for definitive surgical intervention. Emergency hemorrhoidectomy was successfully performed under appropriate anesthesia. Postoperatively, the patient was managed with analgesics, sitz baths, stool softeners, and antibiotics. Recovery was uneventful, and he was discharged in stable condition with advice on dietary and lifestyle modifications.
Conclusion: Strangulated hemorrhoids are surgical emergencies requiring prompt recognition and intervention. Delay in seeking medical care or the use of unverified local remedies can exacerbate the condition, leading to necrosis and systemic infection. Early surgical management remains the definitive treatment with favorable outcomes.
Keywords:
Strangulated hemorrhoid; Grade IV hemorrhoidal disease; Hemorrhoidectomy; Anorectal emergency
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