Clinical Report: Comprehensive Care for Grade III Circumferential Mixed Hemorrhoids

Overview

This case study details the successful surgical management of Grade III circumferential mixed hemorrhoids in a 33-year-old male with Marfan syndrome on long-term anticoagulation. A structured multidisciplinary approach was essential to balance the risks of thrombosis and postoperative bleeding.

Background

Marfan syndrome (MFS) is a connective tissue disorder that often necessitates complex cardiovascular surgeries and lifelong anticoagulation, complicating the management of common conditions like hemorrhoids. The treatment of advanced hemorrhoidal disease in patients on anticoagulation poses significant clinical challenges, particularly in balancing the risks of bleeding and thromboembolism. Understanding effective management strategies in this population is crucial for improving patient outcomes.

Data Highlights

No numerical or trial data provided in the article.

Key Findings

• A multidisciplinary team approach was utilized for individualized perioperative management.
• Preoperative warfarin interruption was shortened to 3 days with enoxaparin bridging.
• The patient underwent external dissection and internal ligation combined with sclerotherapy, resulting in minimal intraoperative blood loss.
• Postoperative management included a 25-day inpatient observation for close INR titration and controlled bowel management.
• At 41 months follow-up, the patient had no recurrent prolapse or severe hemorrhagic complications.

Clinical Implications

This case underscores the importance of a tailored, multidisciplinary approach in managing complex cases of hemorrhoids in patients on anticoagulation. Clinicians should consider individualized perioperative strategies to mitigate risks associated with anticoagulation while addressing the patient's hemorrhoidal disease effectively.

Conclusion

The successful management of advanced hemorrhoids in a patient with Marfan syndrome on anticoagulation highlights the potential for surgical intervention within a structured care pathway. Further validation of these strategies is warranted to enhance clinical practice.

Related Resources & Content

1. Techniques in Coloproctology, 2016 -- Evaluating the Safety of Transanal Hemorrhoidal Dearterialization (THD) in Patients on Anticoagulant Therapy
2. Techniques in Coloproctology, 2014 -- A 3-Year Follow-Up Comparison of Hemorrhoidal Artery Dearterialization with Mucopexy and Hemorrhoidectomy: Results from a Randomized Controlled Trial
3. Frontiers in Medicine, 2026 -- Impact of internet-based multidisciplinary management model on continuity of care intervention for postoperative outcomes in patients with mixed hemorrhoids: a retrospective cohort study
4. Management of Hemorrhoids (2024) | ASCRS Toolkit - FREE Resources
5. 2024 AHA/ACC Perioperative CV Management Guideline: Key Points - American College of Cardiology
6. Evaluation of Long-Term Results After Milligan-Morgan Hemorrhoidectomy Using Doppler Transperineal Ultrasound and Endoscopy: A Preliminary Investigation
7. Management of Hemorrhoids (2024) | ASCRS Toolkit - FREE Resources
8. https://www.escardio.org/static-file/Escardio/Guidelines/Products/Slide%20sets/2025/2025%20official%20slides_VHD.pdf
9. 2024 AHA/ACC Perioperative CV Management Guideline: Key Points - American College of Cardiology
10. Bentall Procedure: A Standard for Managing Large Aortic Root Aneurysm in Marfan Syndrome - PubMed