Refractory Rectal Ulcer Secondary to Infrared Coagulation Treated with Canasa Suppository

Abstract

Purpose: Rectal ulcer is an uncommon rectal disorder that can present with bleeding, passage of mucus, and sense of incomplete evacuation. Solitary rectal ulcer is the most common type of rectal ulcer. Other less common causes include infection, ischemia, idiopathic, radiation, malignancy or medications. Here we report two cases of rectal ulcers secondary to hemorrhoid treatment, treated successfully with Canasa suppository. Methods: Two patients with grade II internal hemorrhoid treated with Infrared coagulation (IRC). Both patients developed rectal ulcer at the site of the application with intermittent bleeding. Initially they were treated conservatively with stool bulking agents and Anusol suppository, unsuccessfully. Canasa suppository were applied QHS for one month. Both achieved complete healing of there ulcers and symptoms. Results: Both patients achieved complete healing of there ulcers and symptoms. Repeat flexible sigmoidoscopy showed complete healing of the ulcer. No further treatment was required. Conclusion: Nonsurgical therapy for hemorrhoidal disease grades I and II with infrared photocoagulation, banding, bipolar and laser coagulation is a good alternative to surgery; it is painless, suitable as an outpatient procedure and its cost is low. These treatment are complicated occasionally with delayed rectal bleeding, urinary retention, pain, and fever. Treating this complication is very important for the practicing Gastroenterologist. Canasa is a new addition to our armamentarium for treating refractory rectal ulcers secondary to such hemorrhoidal treatment.