A 54-year-old man complaining of massive rectal bleeding and severe anemia was referred to our endoscopic center by the surgical unit. He had undergone stapled hemorrhoidectomy with Longo’s technique 3 weeks before, and had received topical steroid and mesalamine therapy for 1 week without clinical improvement.
Rectosigmoidoscopy was scheduled and performed, showing a 3-cm dehiscence caused by impaired or delayed wound healing at the dentate line ( Fig. 1 ). During the same procedure, 3 ml of the novel hemostatic gel Purastat was applied to obtain formation of a synthetic clot covering the entire dehiscence area. No bleeding or other complications were observed during or after the procedure ( Fig. 2 ).
Fig. 1.
Rectosigmoidoscopic view of 3-cm posthemorroidectomy wound dehiscence at the dentate line.
Fig. 2.
Endoscopic application of the novel hemostatic gel.
Four weeks later, the patient underwent scheduled follow-up rectosigmoidoscopy, which showed scarring of the area with complete mucosal healing ( Fig. 3 ). No bleeding, tenesmus, or other symptoms were reported by the patient ( Video 1 ).
Fig. 3.
Efficacy of the hemostatic gel in wound healing. The wound is shown a before the procedure and b 4 weeks after application of the hemostatic gel.
Video 1 Endoscopic application of a novel hemostatic gel to treat wound dehiscence after stapled hemorrhoidectomy.
Wound dehiscence is an early complication of stapled hemorrhoidectomy, with a prevalence of 3 %–5 %; it has been attributed to malfunctioning staplers and surgical inexperience, and surgical revision is often required 1 . Purastat is an uncolored, fully synthetic, viscous peptide hydrogel that self-assembles into fibers forming a sort of extracellular matrix; this matrix then acts as a mechanical barrier on the bleeding source, providing a hemostatic effect 2 . In addition to the known hemostatic effect, it has been hypothesized that the similarity of the 3 D nanostructure of activated Purastat to the natural extracellular matrix scaffold material favors cell and tissue proliferative processes, leading to more effective mucosal healing 3 .
This treatment may become a valid alternative to revision surgery in patients with wound dehiscence following stapled hemorrhoidectomy.
Endoscopy_UCTN_Code_CCL_1AD_2AJ
Footnotes
Conflict of interest The authors declare that they have no conflict of interest.
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References
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