Abstract：
Perirectal hematoma (PH) is one of the most feared complications of stapling procedures. Literature reviews have reported only a few works on PH, most of them describing isolated treatment approaches and severe outcomes. The aim of this study was to analyze a homogenous case series of PH and to define a treatment algorithm for huge postoperative PHs. A retrospective analysis of a prospective database of three high-volume proctology units was performed between 2008 and 2018, and all PH cases were analyzed. In all, 3058 patients underwent stapling procedures for hemorrhoidal disease or obstructed defecation syndrome with internal prolapse. Among these, 14 (0.46%) large PH cases were reported, and 12 of these hematomas were stable and treated conservatively (antibiotics and CT/laboratory test monitoring); most of them were resolved with spontaneous drainage. Two patients with progressive PH (signs of active bleeding and peritonism) were submitted to CT and arteriography to evaluate the source of bleeding, which was subsequently closed by embolization. This approach helped ensure that no patients with PH were referred for major abdominal surgery. Most PH cases are stable and treatable with a conservative approach, evolving with self-drainage. Progressive hematomas are rare and should undergo angiography with embolization to minimize the possibility of major surgery and severe complications.
摘要：
直肠周围血肿（PH）是吻合手术最令人恐惧的并发症之一。文献综述只报道了一些关于PH的作品，他们中的大多数描述孤立的治疗方法和严重的结果。这项研究的目的是分析PH的同质病例系列，并为大型术后PHs定义治疗算法。在2008年至2018年之间对三个高容量直肠单元的前瞻性数据库进行了回顾性分析，并分析了所有PH病例。总之,3058例患者因痔疮疾病或排便障碍综合征伴内部脱垂而接受了吻合术。其中,报告了14例（0.46%）大PH病例，这些血肿中的12例稳定且保守治疗(抗生素和CT/实验室检查监测);其中大多数通过自发引流解决。两名患有进行性PH（活动性出血和腹水症状）的患者接受CT和动脉造影以评估出血来源，随后通过栓塞封闭。这种方法有助于确保没有PH患者被推荐进行大型腹部手术。大多数PH病例是稳定的，可以用保守的方法治疗，随着自我排水而进化。进行性血肿很少见，应进行血管造影栓塞，以最大程度地减少大手术和严重并发症的可能性。
