Mucocele: a rare complication encountered after stapled haemorrhoidopexy

Stapled haemorrhoidopexy (SH) has resulted in a unique collection of procedural complications with postoperative mucocele 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