Morphological changes in hemorrhoids and distribution pattern of drug after sclerosing treatment of hemorrhoids

Aim of investigation. Studying of the morphological changes in hemorrhoids after sclerosing treatment, and evaluation of injected agent diffusion in the area of injections.

Stuff and methods. From December 2006 to October 2007 93 patients with chronic hemorrhoids of 1 to 4 stages after sclerosing treatment by 3% etoxysclerol solution were included in prospective comparative study. Of them sclerotherapy in combination to ultrasonic cavitation was carried out to 33 patients, with application of foam agent – to 31 patient and by traditional method – 29 patients. Ultrasound investigation by the rectal probe was implemented for evaluation of sclerosing agent diffusion. Patients with 3–4 stages of hemorrhoids complicated by moderate anemia (hemoglobin under 90 g/l), sclerotherapy was carried out in preoperative period to stop the bleeding. Hemorrhoidectomy was carried out after increase of hemoglobin over 100–110 g/l.

Results. At morphological study of internal hemorrhoids thrombosis of all or majority of cavernous veins and cushions, irrespective of procedure of injections, has been revealed in no speciemens. The most severe changes were found in connective tissue septa delimiting cavernous veins and around of veins. The degree of manifestation of morphological changes after various variants of sclerotherapy was not identical. At transrectal ultrasound investigation in all cases diffusion of sclerosing agent within submucosal layer for 15–25 mm proximally from injection site has been revealed. It was also found, that the solution injected into 2 hemorrhoids can spread for ¼ – ¾ of intestine circumference.

Conclusions. In no type of sclerosing treatment there was thrombosis of all cavernous veins and cavernous cushions of hemorrhoids in areas of injections. Only at sclerotherapy with ultrasonic cavitation in lumen of some cavernous veins new thrombi were revealed. Obtained data prove that the clinical effect of sclerosing treatment by 3% etoxysclerol solution is not due to thrombosis, but mainly as a result of compression of cavernous veins due to edema at initial stage, followed by sclerotic changes of the connective tissue, surrounding vein. Diffusion of sclerosing agent for 15–25 mm proximally form site of needle injection proves that there is no need to do injections precisely in submucosal layer over internal hemorrhoid as it was proposed earlier by many authors.

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