half circumferential stapler hemorrhoidopexy in grade 4 gangrenous hemorrhoids with maggots

Jaya Maheshwari, M, S. jyoti hospital

male aged 32 years admitted with complain of swelling , bleeding and pain perianal region since three days.On examination ,there were gangrenous hemorrhoids prolapsed outside the anal canal with maggot infestation.Supportive therapy with intravenous dextrose, antibiotics ,analgesic and anti inflammatory drugs started, along with perianal care, for the infected hemorrhoids. He was taken for hemorrhoid surgery after 48 hours, as the infection and swelling reduced. intraoperatively, there were still maggots live and dead both ,inside the submucosal plains all around the anal canal which were cleared.The anterior half of anal mucosa was found to be sloughed,and gangrenous, sloughing hemorrhoids were present in the posterior half. To correct the posterior prolapsing hemorrhoids the sutures were taken in mucosa at 3, 6, and 9 o clock with prolene 1-0,just above the apex of hemorrhoids. stapler PPH 03, ETHICON fired and hemostasis achieved by rectal mucopexy at bleeding points.anteriorly debridement with excision of external hemorrhoid done with RF.The postoperative period was uneventful and patient discharged in 24 hours.