Gangrenous Hemorrhoids

I'll let that title sink in for a minute. Think about it. I was shocked, when I read it on the specimen source sheet yesterday. I have seen a lot of hemorrhoids under the scope. Not as bad to look at as you might think - dilated, blood filled vessels underneath colonic and transitional (anal) mucosa. But gangrenous? That's a new dimension of hemorrhoid.

I've seen gangrenous limbs and extremities - fingers, toes, knee stumps, etc. The thought of gangrenous hemorrhoids elicited an olfactory sensation that was both curious and revolting. The combination of the scent of gangrene mixed with the anal extrusion of grape-like clusters of swollen blood vessels.

Then I thought of the neglect involved that would lead to gangrenous hemorrhoids. Was this person mentally stable? In a long term care facility with shady staff members that let their clients sit in wheelchairs in the corner of the room for days on end? What type of situation would generate gangrenous hemorrhoids?

I mentally prepared myself for the sight of gangrene superimposed onto hemorrhoids under the scope. Gangrene is not as ugly as you might think - an eosinophilic, basophilic (purple-y pink) smudge of necrotic cells infiltrated by neutrophils (purulence). Microscopic neutrophils are a lot cuter than gross pus. Tiny multi-lobed globes.

I searched for the tell-tale signs of gangrene, but they weren't there. Flipped to high power, and hunted around. Where was the gangrene? There was a little ulceration, but no gangrenous necrosis. I guess if someone looked at ulcerated hemorrhoids they might think they were gangrenous, and describe them as such. But there is a big difference between ulceration and gangrene.

So I've yet to see gangrenous hemorrhoids. A bit of a relief. But I enjoyed thinking about them, and wonder if they really exist. I decided it would make a great derogatory term for your worst enemy. The low-ball. The verbal gut-punch. "You are a gangrenous hemorrhoid."