For one man in the UK, a routine treatment for hemorrhoids resulted in a rare, life-threatening complication that required a number of surgeries and powerful antibiotics to save his life, according to a new report of his case.
The 80-year-old man had undergone rubber band ligation to treat inflamed hemorrhoids, a common outpatient procedure that a doctor performs in the office. In rubber band ligation, a small elastic band is tied around the base of hemorrhoid, which is a swollen blood vessel in the rectum or anus. The band cuts off the blood flow, and the hemorrhoid shrinks and falls off within a few days.
Rubber band ligation is the most commonly used technique for treating inflamed hemorrhoids because it is an effective, low-risk treatment, said Dr. Daryl Subramaniam, a surgeon at Royal Sussex County Hospital, in East Sussex, who treated the man. But doctors performing the procedure should make sure they inform their patients to be vigilant about the "danger signs" of complications, Subramaniam said.
The patient in this case thought that it was normal to have pain following the procedure, and delayed seeking medical help.
Four days after the procedure, the man felt increasing pain and swelling. Two weeks after that, he went to the emergency department, but by then he had developed an infection that had progressed into gangrene, a condition in which body tissue dies.
"If the patient had sought medical attention as soon as his pain had started, then it is possible the infection could have been treated with strong antibiotics alone," without surgery, Subramaniam said. "By the time this patient had presented to us, dead tissue was visible and we were left with no other option but to proceed with surgery."
During multiple rounds of surgery, doctors removed layers of dead tissue to stop the spreading infection, according to the report published Nov. 28 in the journal BMJ.
The man's condition is called Fournier gangrene, which is a rapidly spreading necrotizing infection in the genitalia or anal regions, spurred by bacteria found in those areas. [7 Devastating Infectious Diseases]
Treating the condition is difficult because "even if all the visible dead tissue is removed at the initial operation, more dead tissue may reoccur rapidly as the infection spreads, necessitating more and more complex operations over a short period of time, which of course puts a great strain on a patient's health," Subramaniam told LiveScience.
Fournier gangrene is a rare condition, affecting 1 to 2 in every 100,000 people, and is much more common in men than women. Left untreated, the condition is fatal. With surgical treatment, it is estimated that up to 40 percent of patients may still die from the infection, the researchers said.
The man lived, making steady progress over the following weeks. He is currently awaiting plastic surgery reconstruction, when he is deemed fit enough for the procedure, Subramaniam said.
Subramaniam said this patient was the first case of Fournier gangrene that developed following a hemorrhoidal banding procedure that he and his fellow surgeons had seen.
"A bit of pain or bleeding is to be expected at the time of the procedure, but if the pain is ongoing, or fever or urinary retention develops patients should seek immediate medical attention."
This is particularly important in those patients at higher risk for complications, Subramaniam said. High-risk patients for this condition include the elderly, people with diabetes, and those with chronic kidney disease, liver failure, AIDS, cancer and obesity.
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