A combined method for the treatment of grade IV internal haemorrhoidal disease.

A 48-year-old patient presented acutely in our emergency department, reporting a fainting episode that took place several minutes prior, as well as contin-uous rectal blood loss. The patient’s prior medical his-tory included known grade IV haemorrhoidal disease for the past 33 years, as well as one more instance of hospitalization for haemorrhoid-associated blood loss. Examination of the patient’s vital signs revealed a blood pressure of 98/67 mm Hg and a pulse rate of 68 bpm, while the respiratory rate and temperature were within the normal limits. Anorectal inspection revealed massive, grade IV internal haemorrhoidal disease, with nu-merous prolapsed and ulcerated haemorrhoids as well as active bleeding sites. Digital palpation of the rectum returned stool of normal consistency, as well as ample fresh blood. Complete blood count report returned he-moglobin (Hb) values of 7.0 g/dl