Hemorrhoids can be a source of obscure gastrointestinal bleeding that requires transfusion: report of five patients

PURPOSE: Hemorrhoids have been rarely reported to be a source of transfusion-dependent, obscure gastrointestinal bleeding. We report the diagnosis and management of a series of patients in whom hemorrhoids were the source of obscure gastrointestinal bleeding that was severe enough to require transfusion.

METHODS: Five patients, who presented with severe hematochezia or obscure gastrointestinal bleeding, during a 24-month period had had an extensive workup for gastrointestinal bleeding. All had required transfusion of 2 units or more of blood. In the absence of other causes of bleeding, the five patients had unprepared flexible sigmoidoscopy on the same day that they reported hematochezia to exclude a proximal source of bleeding. All were found to have internal hemorrhoids as a likely source of bleeding, which was confirmed at exploration under anesthesia, and were treated by surgical hemorrhoidectomy.

RESULTS: The five patients underwent surgical, Ferguson-type, hemorrhoidectomy. One patient required 1 unit of blood immediately postoperatively, but none have required further transfusion or reported hematochezia in more than three months of follow-up.

CONCLUSIONS: We have shown that hemorrhoids can be a source of transfusion-dependent, obscure gastrointestinal bleeding. This aspect of the common problem of hemorrhoidal bleeding has not been previously reported, which reflects underreporting or missed diagnosis.