Hemorrhagic Shock from Massive Retroperitoneal and Pelvic Hematoma After Stapled Hemorrhoidopexy

Background: Massive retroperitoneal and pelvic hematoma leading to hemorrhagic shock following stapled hemorrhoidectomy is rare. To the best of our knowledge at time this publication, there are no reported cases postoperative or without intraluminal bleeding after hemorrhoidopexy. We describe such a case in patient with grade III internal hemorrhoid who was treated colonoscopy hemorrhoidectomy. Case Summary: A 64-year-old female past medical history significant for deep vein thrombosis pulmonary embolism which she anticoagulated warfarin presented hemorrhoids rectal associated iron deficiency anemia. The held five days prior planned combined procedure. While still recovering post-anaesthesia care unit (PACU) few hours post-operatively, found be hypotensive, tachycardic, somnolent. CT abdomen/pelvis obtained, identified large collection blood pelvis retroperitoneum. She taken back OR an emergent exploratory laparotomy flexible sigmoidoscopy. admitted ICU where required placement on BiPAP respiratory acidosis resuscitation total seven units pRBCs two FFP. clinically stable three later. Conclusion: In chronic anticoagulation, one should consider intraluminal, retroperitoneal, if Furthermore, not rule out possibility even evidence bleeding. Emergent sigmoidoscopy may considered unstable patients unidentified external