Anal Stenosis Following Sclerotherapy for Hemorrhoids: A Case Report

INTRODUCTION Sclerotherapy is a widely used non-surgical treatment for hemorrhoids but can lead to rare severe complications. We present a case of severe anal stenosis developing one year after sclerotherapy, a debilitating iatrogenic complication. PRESENTATION OF CASE A female patient presented with progressive difficulty in defecation for one year, acutely worsened over five days. One year prior, she underwent sclerotherapy for mixed hemorrhoids. Physical examination revealed severe anal stenosis admitting only the fingertip. Endoscopy and pelvic MRI confirmed a tight cicatricial stricture. She underwent V-Y advancement flap anoplasty combined with stricture incision. DISCUSSION Post-sclerotherapy stenosis results from excessive submucosal fibrosis and scar contracture. Diagnosis is primarily clinical, supported by endoscopy to exclude malignancy. Severe strictures require surgical correction. V-Y advancement flap anoplasty effectively relieves stenosis by introducing healthy tissue into the anal canal. CONCLUSION The patient achieved an excellent postoperative outcome with restored bowel function. Severe anal stenosis is a rare but devastating complication of hemorrhoid sclerotherapy. This case underscores the efficacy of V-Y advancement flap anoplasty. Clinicians should maintain high suspicion for this complication in patients with obstructive defecation symptoms post-injection.