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Abstract: The patient visited the hospital for fresh blood in the stool and reported that there was also a prolapsed anal mass, and was diagnosed with stage III internal hemorrhoids after medical history and specialist anal examination, and eventually chose minimally invasive surgical treatment with medication. The patient was successfully discharged after 5 days of hospitalization, and during the follow-up, the blood in the stool disappeared and the internal hemorrhoid no longer prolapsed, and the patient expressed satisfaction with the treatment result.
Basic information】Male, 54 years old
Disease Type】Stage III internal hemorrhoid
Hospital】Hegang City People’s Hospital
Date of Consultation】January 2021
Treatment plan] Selective suprahemorrhoidal mucosal resection + oral cefuroxime tablets to prevent infection + dilute potassium permanganate solution sitz bath
Treatment Period】5 days hospitalization, half year follow-up
Results】No more internal hemorrhoids prolapsed, blood in the stool disappeared
I. Initial consultation
The patient visited the clinic because of the symptoms of fresh blood in the stool in the last week, and asked about the course of the disease. We learned that the patient had a prolapsed anal swelling during stool one year ago, which returned to the anus by itself after stooling. The anal examination showed that the anus was in a normal position and no swelling was palpable in the anus. The patient could see the swelling prolapsing from the anus when the abdominal pressure increased, and the anoscope showed that the mucous membrane of the swelling was congested and swollen, and the vesicular surface was visible.
II. Treatment process
The patient’s internal hemorrhoid diagnosis was clear that it was stage III internal hemorrhoid, and conservative treatment was ineffective, so surgical treatment was recommended. After admission, all routine tests (routine blood, coagulation, biochemistry, infectious diseases, etc.) were completed. The routine blood indicated normal red blood cells and hemoglobin, no anemia, and no abnormal coagulation tests. After bowel cleansing the next day, the patient was given a selective suprahemorrhoidal mucosal resection under lumbar anesthesia, and the procedure went smoothly and without accidents for about 15 minutes. After the operation, the patient had only slight anal swelling pain, which was tolerable, and was given oral cefuroxime tablets to prevent infection, as well as a sitz bath with diluted potassium permanganate solution and a disinfectant change of the anal area after the sitz bath. 2 days later, the patient had normal stools without blood and no swelling prolapsed from the anus, and the patient was discharged after 5 days of hospitalization. The patient had no discomfort and was discharged after 5 days of hospitalization. After six months of follow-up after discharge, the anal function was normal and no complications such as anal canal stenosis occurred.
III. Treatment effect
The patient was a stage III internal hemorrhoid with symptoms of blood in the stool. After minimally invasive surgery, the internal hemorrhoid was removed, no more swelling prolapsed from the anus and no blood in the stool, and the postoperative effect was very obvious. During the follow-up, the appearance and function of the patient’s anus were normal, and there was no complication of anal canal stenosis, and the patient obtained a satisfactory treatment effect.
IV. Notes
We are glad that after the treatment the patient’s internal hemorrhoids no longer prolapse and the blood in the stool disappears. Patients need to have a light diet and liquid diet for 3 days after surgery, and then gradually transition to normal diet, and can drink a glass of honey water in the morning to prevent dry stools. When there is difficulty in anal defecation, do not violently defecate, you can squeeze in the anal cork or enema to defecate, patients should also pay attention to diet after discharge, stay away from spicy and stimulating food, do not sit, squat and stand for a long time, and do more anal lifting exercises to prevent internal hemorrhoids from reappearing. Patients should use cephalosporin antibiotics to prevent infection after surgery and refrain from drinking alcohol for 2 weeks to avoid disulfiram reaction.
V. Personal insight
The patient’s history of internal hemorrhoid was actually as long as 1 year, and there were no obvious discomfort symptoms at the beginning, and no treatment and therapy were given, and he was allowed to develop until he came to the hospital when he had fresh blood in the stool, which had developed to stage III at the time of consultation, and lost the opportunity of conservative treatment with drugs, and it was good that the patient could come to the hospital in time after the appearance of blood in the stool, and did not develop into internal hemorrhoid impaction at the time of consultation, and did not have serious complications such as hemorrhagic anemia, and was treated with minimally invasive After treatment, satisfactory results were obtained. Therefore, early diagnosis and early treatment are recommended for internal hemorrhoids. In addition, many patients think that the hemorrhoid surgery will not recur, and resume bad habits such as drinking and sedentary, which is not true, the human anus downward, the role of gravity prone to hemorrhoidal venous reflux obstruction, coupled with bad dietary habits and lifestyle, it is easy to cause the recurrence of hemorrhoids.