Challenges in the management of major hemorrhage after hemorrhoidal banding

Abstract

Hemorrhoidal banding is considered a safe, low-risk technique for the management of grade-I–III internal hemorrhoids. Furthermore, information in the literature regarding serious complications associated with banding is limited. Bleeding post hemorrhoidal banding is often considered minor and is expected to resolve spontaneously. Therefore, major hemorrhage post hemorrhoidal banding is often unexpected, recognized late, poorly managed, and may become life-threatening. In this case series, we present two unusual cases with rare, major, life-threatening hemorrhage post banding. Although it is rare, banding is shown to be associated with a risk of life-threatening bleeding, as this report highlights. Major hemorrhage is unusual because most bleeding after hemorrhoidal banding resolves spontaneously; however, as shown in this series, bleeding is a potential complication of hemorrhoidal banding. Thus, an appropriate index of suspicion is important to prevent serious morbidity and mortality. In this study, we discuss the factors associated with bleeding risk as well as surgical and management strategies to reduce the risk of major bleeding with hemorrhoidal banding.