Management of retrorectal hematoma after stapled transanal rectal resection for prolapsed hemorrhoids associated with occult rectal prolapse and obstructed defecation syndrome

A 47-year-old woman with prolapsed hemorrhoids associated with occult rectal prolapse and obstructed defecation syndrome underwent a stapled transanal rectal resection with TST36 high-volume stapler. The postoperative course was complicated by tenesmus and anal pain with severe anemia. The rectal examination revealed the presence of swelling compatible with hematoma. An abdominal computed tomography scan revealed a huge perirectal hematoma (Figs. 1, 2, 3, 4). The patient was transfused and treated with infusion of intravenous fluids and broad-spectrum antibiotics with resolution of the clinical picture. She was discharged on day 10. At the first outpatient visit, 1 week after discharge, fistulization of the endorectal suture was found with an abscess at the site of the hematoma. The patient underwent daily washing with saline solution until complete abscess reabsorption. At 3- and 6-month follow-up the patient was asymptomatic.