PDF(Pubmed)
Abstract：
Transanal hemorrhoidal dearterialization (THD) is a minimally invasive procedure that has gained popularity as a treatment for symptomatic hemorrhoids. It involves ligating the arterial blood supply to the hemorrhoidal plexus. Compared to conventional ligation or resection, THD is associated with less postoperative bleeding and pain, allowing for same-day surgery discharge. Horseshoe abscess is a rare but known complication of anorectal surgery, characterized by an abscess that extends around the anal canal, often involving the ischiorectal fossa and adjacent structures. Although horseshoe abscesses have been reported after various anorectal surgeries, including hemorrhoidectomy, their occurrence following THD has not been well-documented in the literature. A 72-year-old male underwent THD for rectal prolapse with internal hemorrhoids and presented to the hospital on postoperative day 6 with severe rectal pain. A computed tomography (CT) scan revealed a large complex horseshoe perirectal abscess with fluid and air and significant rectal wall thickening. A rectal examination under anesthesia confirmed the presence of purulent drainage from the anus, and surgical drainage of the abscess was performed. The patient received antibiotics and analgesics and experienced a favorable recovery. The exact pathophysiology of a horseshoe abscess following THD remains unclear, and the incidence and risk factors associated with this complication are not well-established. Moreover, there has yet to be a consensus on the optimal management of horseshoe abscesses after THD, whether through surgical or medical approaches. This case emphasizes the importance of considering horseshoe abscess as a potential complication of THD and highlights the need for further research to understand better its incidence, risk factors, and optimal management strategies.
摘要：
经肛门痔去动脉化（THD）是一种微创手术，已成为有症状痔疮的治疗方法。它涉及结扎痔丛的动脉血供。与常规结扎或切除相比，THD与术后出血和疼痛减少有关，允许当天手术出院。马蹄形脓肿是一种罕见但已知的肛肠手术并发症，以围绕肛管延伸的脓肿为特征，常累及坐骨直肠窝和邻近结构。尽管在各种肛门直肠手术后都有马蹄形脓肿的报道，包括痔疮切除术,它们在THD后的发生在文献中没有得到很好的记录。一名72岁的男性因直肠脱垂伴内痔而接受了THD，并在术后第6天因严重的直肠疼痛被送往医院。计算机断层扫描（CT）扫描显示大型复杂的马蹄形直肠周围脓肿，伴有液体和空气，直肠壁明显增厚。麻醉下的直肠检查证实肛门存在脓性引流，并对脓肿进行手术引流。患者接受了抗生素和镇痛药，恢复良好。THD后马蹄形脓肿的确切病理生理学尚不清楚，与该并发症相关的发生率和危险因素尚不明确。此外，关于THD后马蹄形脓肿的最佳管理尚未达成共识，无论是通过手术还是医疗方法。该病例强调了将马蹄形脓肿视为THD潜在并发症的重要性，并强调需要进一步研究以更好地了解其发病率。危险因素，和优化管理策略。
