Anorectal pseudoaneurysm after stapled anopexy leading to recurrent massive bleeding per rectum: a case report

Abstract Introduction Stapled anopexy is a modern technique to treat symptomatic grade 3 and grade 4 internal haemorrhoids. It has advantage of early recovery, less pain, and short procedure time as compared to conventional haemorrhoidectomy. Frequency of post anopexy bleeding per rectum requiring reoperation is 1.5% to 3.3% and staple line is identified to be the most common site. To date no case has been reported describing arterial pseudoaneurysm as the cause of recurrent rectal bleeding after stapled anopexy. Case Report We present a case of a 47-year-old Asian male patient, who underwent stapled anopexy and had recurrent profuse bleeding per rectum in the two weeks following surgery. Work up including colonoscopy and computerised tomographic angiography showed arterial pseudoaneurysm with partial thrombosis in the perianal area. Non-invasive management with close observation was successful. Staple injury to the vessel wall during procedure was most likely the cause of pseudoaneurysm formation. Conclusion Bleeding of pseudoaneurysmal origin should be in differential diagnosis of the patients presenting with persistent bleeding per rectum after stapled anopexy and meticulous techniques should be adopted during procedure. Invasive treatment options of arterial pseudoaneurysm can be reserved for cases where non-invasive management is not successful.