Abstract
BackgroundInternal hemorrhoids are the most common anal diseases. Aluminum potassium sulfate and tannic acid (ALTA) injection is a new sclerosing therapy for the treatment of internal hemorrhoids. Although ALTA injection has been widely used, there are no previous reports of rectal cancer patients who underwent robot-assisted low anterior resection (Rob-LAR) after ALTA injection to treat internal hemorrhoids.Case presentationA 70-year-old man with rectal cancer was presented to our hospital. He had an ALTA injection 2 months before presentation at a clinic due to hematochezia with internal hemorrhoids. The rectal tumor was located 7 cm above the anal verge, and Rob-LAR with the da Vinci Xi system was performed. The patient had sclerosis on the stump of the anal side, which made it difficult to transect the rectum with linear staplers. This required multiple repeats of compression through the SmartClamp feedback. After anastomosis with the double-stapling technique, we constructed a diverting ileostomy.ConclusionAlthough ALTA injection is a promising strategy for internal hemorrhoids, rectal cancer should be excluded before the sclerosing therapy.
Highlights
Internal hemorrhoids are the most common anal diseases
aluminum potassium sulfate and tannic acid (ALTA) injection is a promising strategy for internal hemorrhoids, rectal cancer should be excluded before the sclerosing therapy
Even if patients do not have rectal tumors when treated with ALTA sclerotherapy, they could develop rectal tumors afterwards that require surgical treatment
Summary
The presence of rectal cancer should be ruled out before injection sclerotherapy for internal hemorrhoids.
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