Objective:

To report the case of a patient with Marfan syndrome requiring complex management of Grade III circumferential mixed hemorrhoids while on long-term anticoagulation, highlighting the clinical challenges and management strategies involved.

Key Findings:

• The patient had persistent Grade III circumferential mixed hemorrhoids unresponsive to conservative management, necessitating surgical intervention.
• Surgical intervention was performed with minimal intraoperative blood loss, demonstrating the effectiveness of the MDT approach.
• At 41 months follow-up, there were no recurrent prolapse or severe hemorrhagic complications, indicating successful long-term management.

Interpretation:

Surgical intervention for advanced hemorrhoids in anticoagulated patients with Marfan syndrome can be feasible when managed within a structured multidisciplinary framework, suggesting a model for similar future cases.

Limitations:

• The strategies described are patient-specific and require further validation through larger studies.
• The case study does not provide a broader analysis of outcomes across a larger patient population, which may limit generalizability.

Conclusion:

The case illustrates the complexity of managing hemorrhoidal disease in patients on anticoagulation and the importance of individualized care.