Rectal Mucocele: A Rare Complication of Stapled Haemorrhoidopexy Surgery

Rectal Mucocele is a rare and preventable complication of stapled haemorrhoidopexy surgery according to a recent study published in the BMC Surgery.

Haemorrhoids are the commonest anorectal disorder and it is estimated that 50% of the population over the age of 50 years suffer from the condition. Traditional open haemorrhoidectomy remains the gold standard in the surgical management of circumferential prolapsed haemorrhoids. Moreover, many surgeons are attempting to use stapled haemorrhoidopexy (SH) because of reported advantages over open variants of haemorrhoidectomy which include a shorter operating time, less postoperative pain, better wound healing, and an earlier return to work.

Stapled haemorrhoidopexy (SH) has resulted in a unique collection of procedural complications with postoperative mucocele being a particularly rare example. This study is designed to comprehensively describe the characteristics of rectal mucocele and discuss its pathogenesis following Stapled haemorrhoidopexy surgery.

A database of patients presenting with a rectal mucocele following an SH procedure was established and studied retrospectively.

Results of the Study

• Seven patients were identified.
• All patients complained of variable anal discomfort with 5/7 presenting with inconstant anal pain, 2 with de novo evacuatory difficulty. These cases appeared at a median time of 6 months after Stapled haemorrhoidopexy surgery.
• None of the patients presented with intermittent fevers and rectal bleeding.
• Digital rectal examination revealed a pararectal mass in every case which was anterior in 1, anterolateral in 3, posterolateral in 2, lateral in 2, and posterior in 1. Two masses were palpated in two patients.
• These masses were morphologically heterogeneous and comprised mostly of cystic components with a variable size ranging from 0.5 × 0.8 cm up to 3.3 × 4.5 cm.

Thus, rectal mucocele develops when mucosal fragments become embedded and isolated under the mucosa. It is a preventable complication of Stapled haemorrhoidopexy surgery by ensuring correct purse string placement prior to stapled haemorrhoid excision.

Reference

Wan, XY., Fu, YJ., Li, GM. et al. Mucocele: a rare complication following stapled haemorrhoidopexy. BMC Surg 22, 298 (2022). https://doi.org/10.1186/s12893-022-01744-3