Emborrhoid in patients with portal hypertension and chronic hemorrhoidal bleeding: preliminary results in five cases wit
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Emborrhoid in patients with portal hypertension and chronic hemorrhoidal bleeding: preliminary results in five cases with a new coiling release fashion “Spaghetti technique” Francesco Giurazza1 · Fabio Corvino1 · Errico Cavaglià1 · Mattia Silvestre1 · Gianluca Cangiano1 · Francesco Amodio1 · Giuseppe De Magistris1 · Raffaella Niola1 Received: 19 November 2019 / Accepted: 2 April 2020 © Italian Society of Medical Radiology 2020
Abstract Purpose This manuscript reports on a preliminary experience concerning emborrhoid in patients affected by cirrhotic portal hypertension; furthermore, a novel customized technique of coils release, named “Spaghetti technique,” is described. Materials and methods Five patients with chronic anemia due to internal hemorrhoidal bleeding and cirrhotic portal hypertension were treated. Clinics and hemoglobin values were evaluated to objectively assess clinical conditions up to 3 months follow-up. Embolizations were performed with fibered coils, oversized, released stretched and not packed. Results Technical success, intended as occlusion of all superior hemorrhoidal artery branches, was 100%. In two patients, inferior hemorrhoidal arteries were embolized too. No patients reported major or minor complications. At 3-month followup, clinical improvement was obtained in four of the five patients; hemoglobin values improved or remained stable in the whole sample. Conclusions Based on this limited experience, emborrhoid seems to be safe and effective at 3-month follow-up to improve symptoms in patients with cirrhotic portal hypertension and chronic anemia due to hemorroidal bleeding; the stretched fashion to release oversized coils provides effective embolization. Keywords Emborrhoid · Portal hypertension · Coiling · Hemorrhoids · Bleeding · “Spaghetti technique”
Introduction Hemorrhoidal disease is one of the most common medical conditions in the general population, with a prevalence rate range of 4–35% [1]. 90% of patients are properly managed with conservative medical therapies, while 10% requires surgery [2]. Clinical presentation is characterized by rectal bleeding, causing anemia in the long-term, hemorrhoidal prolapse and anal itch due to tissue exudation and maceration; pain is reported in advanced phases of disease, related to local complications (thrombosis, fissurations, criptitis). All of these aspects lead to significantly worsening the quality of life.
Encouraging results concerning embolization of the superior hemrrhoidal artery (SHA), procedure known as “emborrhoid,” have been published by different authors [3–10]. However, the effectiveness of the technique in cirrhotic patients with portal hypertension has not been yet investigated; it should also be considered that these subjects frequently present with multiple comoribidities and are not optimal candidates for conventional surgery. Here is reported a preliminary experience concerning emborrhoid performed on five patients with cirrhotic portal hypertension and chronic anemia due to hemorrhoidal blee
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