A 31-year-old man with hemorrhaging grade IV and intermittent rectal bleeding of 1 year onset.
Longo circular hemorrhoidopexy was performed without complications.
The patient came to the emergency department six days later due to severe pain and abundant rectal bleeding.
Physical examination showed no abnormalities and hemoglobin 12.7 g/dl.
In the surgical review, a zone of posterior necrosis with active hemorrhagic point was observed.
Hemostatic suture was performed and discharged the next day.
The patient returned 24 h later due to persistent symptoms.
Physical signs and symptoms; hypotension; hemoglobin 9.9 g/dl.
Findings during surgery were similar, with new hemostatic suture and fixation that were not effective.
Hemoglobin decreased during the following hours to 6.8 g/dl, requiring replacement with blood products.
Flexible rectosigmoidoscopy revealed a narrow ulcer of the suture line, occupying 2/3 of the circumference and with a clot attached to one of the edges.
Local treatment consisted of injection of 2.5 cc.
The patient was discharged on the third day, asymptomatic and with hemoglobin 11.4 g/dl.
The control rectosigmoidoscopy 2 months later showed a healed mucosa without alterations.
