Postoperative bleeding is the most common complication, especially heavy bleeding after hemorrhoid surgery. It is a serious complication that cannot be ignored and can even be life-threatening. It is the most valued complication of anorectal doctors.
Bleeding after hemorrhoid surgery is divided into two types: primary and secondary. There are many causes of bleeding, but mainly local factors.
(I) Primary bleeding.
Mostly within a few hours after surgery, it is due to improper operation or imperfect hemostasis on the wound during the operation.
1. The wound is too large and deep, injuring the large A blood vessel without ligation.
2. Cut off the hemorrhoids on the ligature line, and retract and slip.
3. When putting oil gauze into the wound, push off the ligature.
4. The ligation is not tight and loose.
5. With renin effect, contraction during operation, dilation and bleeding after operation.
(Ii) Secondary bleeding
It usually occurs 3-14 days after the operation, when hemorrhoids die off and form wound bleeding.
1. Internal hemorrhoids are ligated, ligated, and injected with necrotic agent for 3-14 days. The hemorrhoid tissue is necrotic and falls off, forming fresh wounds, blood vessel A is not closed, thrombus falls off, and active bleeding.
2. The internal hemorrhoid ligation thread falls off and the suture needle penetrates too deeply, which injures the large blood vessel A. When the hemorrhoids become necrotic and fall off, the blood vessel A in the deep wound is not locked tightly and massive bleeding will occur.
3. Wound injury
During postoperative hemorrhoid shedding and wound repair, vigorous activity or constipation, excessive defecation, tearing the wound and A blood vessel, causing massive bleeding.
4. Certain systemic diseases
For example, thrombocytopenia, prolonged bleeding time, portal hypertension, hypertension, aplastic anemia, hemophilia and other systemic diseases with bleeding tendency were ignored or not actively treated before surgery.
Two, symptoms and signs
Immediate bleeding, bleeding occurred on the day after surgery or within 48 hours.
Secondary hemorrhage is hemorrhage that occurs within 7-14 days after surgery, and is often accompanied by occult hemorrhage in the rectum, a serious complication.
According to the bleeding flow location:
Inward bleeding, inward bleeding is massive hemorrhage in the rectum (also known as occult bleeding). At first, there is no sensation, but as the inflow of blood increases, the lower abdomen becomes full, the anus is burning, and the blood or black blood clots are discharged quickly after the desire to discharge, accompanied by palpitation. , Dizziness, dark eyes, weakness of limbs or even fainting, hemorrhagic shock may be accompanied by not being treated in time.
Outward bleeding, that is, hemorrhage outside the anus, also known as overt bleeding, flows out from the incision and stains clothing. External bleeding is not terrible and can be detected in time.
According to the amount of bleeding: heavy bleeding, moderate bleeding, and small bleeding.
Heavy or moderate bleeding: The bleeding is heavy and acute, the condition is severe, the symptoms and signs are obvious, shock may occur in severe cases, and it must be treated in time.
A small amount of bleeding has no effect on the whole body, and generally has no obvious symptoms or signs.
3. Treatment and treatment:
1. A small amount of bleeding after surgery, pay attention to observation, and no treatment is required. Excessive bleeding should be carefully observed and taken care of closely. Pay attention to changes in BP, P, etc. Rapid transfusion and blood transfusion, immediate diffusion and addition of hemostatic drugs (such as hemostatic sensitivity, Vitk, Anluo blood), etc. to improve blood coagulation and correct shock.
2. Immediately under local anesthesia or sacral anesthesia, clear the hemorrhage in the intestinal cavity, find the bleeding point under anoscope, pull out the wound edge with tissue forceps, and use 4# silk thread or 0# intestine thread through the suture to stop bleeding.
(Be careful not to put the needle too close to the wound, so as not to tear the fragile wound tissue during ligation)
3. It is inconvenient to ligate bleeding points with more bleeding or higher bleeding. You can use gel sponge, oil gauze, or renin gauze to fill and compress the bleeding.
4. Airbag compression: Furui's urinary catheter, condom.
5. Enema: For secondary bleeding, the use of Huang's alum liquid enema has many advantages. It is a non-surgical hemostasis measure with simple, convenient, and inexpensive hemostatic methods.
6. Sclerosing hemostasis method: suitable for secondary bleeding, injection of sclerosing agent such as Xiaozhiling under the mucosa above the bleeding site can achieve satisfactory results.
7. Secondary anemia after hemostasis can be treated with infusion, oral iron, VC, donkey-hide gelatin replenishment, nourishing oral liquid, Buzhong Yiqi Decoction, and Bazhen Decoction.
Pay attention to bed rest, pay proper attention to diet, and keep stool smooth.
The key to the prevention of primary bleeding is correct operation. The hemorrhoids must be ligated tightly when ligating or bandaging. Large hemorrhoids can be ligated through to prevent the thread from slipping off. The incision and the peeling surface should not be too deep or too large. In case of A bleeding, it must be ligated to perfect hemostasis.
Even small bleeding points should be ligated to stop bleeding. Renin is added to local anesthetics. Prevention of secondary bleeding:
1. To ligate the hemorrhoids, the suture should be passed under the mucosa without hurting the muscle layer.
2. The injection of sclerosing or necrotic agent should not penetrate the muscular layer of the intestinal wall too deeply.
3. Do not do excessive activities after the operation and keep the stool smooth.
4. Inject sclerosing agent, pay attention to hemorrhoids A area injection can prevent bleeding.
Bleeding after hemorrhoid surgery is a common complication of hemorrhoids. There are many causes of bleeding. The treatment is very simple, that is, hemostasis. But for patients, regardless of the cause of bleeding, they will blame the doctor for not doing it well. While stopping the bleeding of the patient, we must do a good job of ideological work for the patient and inform the cause of the bleeding to avoid medical disputes. In such a situation, the patient must first stabilize the patient’s mood, and then give intravenous hemostatic drugs and appropriate rehydration. If the above 2 is no problem, do everything possible to find the bleeding site to stop the bleeding. At the same time, look at the color of the blood. Don't be an adhesive ulcer, the second possibility is bleeding from the ligation.
In order to prevent hemorrhoids from bleeding after hemorrhoid surgery, the following points should be emphasized: (1) To understand the medical history in detail before the operation, and to grasp the patient's physical condition, especially for patients with coagulation dysfunction and high blood pressure, carefully prevent the hemorrhoids from falling off after the operation. Period of 5 to 15 days. If there are signs of bleeding, hemostatic drugs should be used continuously for 3 to 5 days; (2) Careful and standardized operations during the operation, especially master the dose and method of injection therapy, and prevent operation when injecting sclerosing agent Improper, over-dose, and deep injection can cause extensive tissue necrosis and induce hemorrhage; (3) Postoperative care should be strengthened and medication should be strictly administered to allow patients to keep their stools unobstructed, avoid strenuous activities, and perform inspections and dressings correctly. When performing digital examinations, anal endoscopy, or expanding the anus, and changing dressings, it is strictly forbidden to use excessive force to damage normal tissues, avoid pulling the ligature prematurely and causing tissue tears, and avoid direct contact with the wound when changing dressings. So as not to puncture the wound and cause bleeding.