External hemorrhoid excision: Difference between revisions
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==Indications== | ==Indications== | ||
*Acute (<72 hours) thrombosed hemorrhoid | *Acute (<72 hours) thrombosed [[external hemorrhoid]] | ||
*Pain/discomfort affects daily life | *Pain/discomfort affects daily life | ||
| Line 16: | Line 16: | ||
==Procedure== | ==Procedure== | ||
#Place patient in side-lying or prone position | #Place patient in side-lying or prone position | ||
#Apply | #Apply lidocaine/prilocaine cream 1 hr prior to procedure | ||
#*Apply tape to each buttock with force directed laterally for better visualization | #*Apply tape to each buttock with force directed laterally for better visualization | ||
#Inject local anesthetic (e.g. [[bupivacaine]] 0.5% with epi) with 30-gauge needle directly into dome of hemorrhoid as a ''single'' injection | #Inject local anesthetic (e.g. [[bupivacaine]] 0.5% with epi) with 30-gauge needle directly into dome of hemorrhoid as a ''single'' injection | ||
| Line 32: | Line 32: | ||
*Recurrence | *Recurrence | ||
*Infection | *Infection | ||
*Fistula | *[[anal fistula|Fistula]] | ||
*Abscess | *[[perianal Abscess|Abscess]] | ||
*Skin tags | *[[anal tags|Skin tags]] | ||
==See Also== | ==See Also== | ||
*[[Hemorrhoids]] | *[[Hemorrhoids]] | ||
*[[Anorectal disorders]] | |||
*[[Internal hemorrhoid]] | |||
*[[External hemorrhoid]] | |||
==External Links== | |||
*[https://www.merckmanuals.com/professional/gastrointestinal-disorders/anorectal-disorders/hemorrhoids?query=external%20hemorrhoid Merk Manual - How To Do Hemorrhoidal Thrombectomy] | |||
===Videos=== | |||
{{#widget:YouTube|id=KU1c1JfpJHM}} | |||
==References== | ==References== | ||
Latest revision as of 00:30, 16 July 2021
Indications
- Acute (<72 hours) thrombosed external hemorrhoid
- Pain/discomfort affects daily life
Contraindications
- Immunocompromised patient
- Pediatric patient
- Pregnant patient
- Portal hypertension
- Coagulopathy
Equipment Needed
- Scalpel
- Local anesthetic
Procedure
- Place patient in side-lying or prone position
- Apply lidocaine/prilocaine cream 1 hr prior to procedure
- Apply tape to each buttock with force directed laterally for better visualization
- Inject local anesthetic (e.g. bupivacaine 0.5% with epi) with 30-gauge needle directly into dome of hemorrhoid as a single injection
- Alternatively, a perianal block can be used for local analgesia
- Make elliptical incision in overlying skin to expose the thrombosis
- Remove the clot and the overlying skin through the incision site
- Control bleeding by tucking corner of a small piece of gauze into the wound and tape buttocks together
- Leave in place for a few hours
- Apply pressure dressing have patient remove 6-12 hr later when takes first stiz bath
- Patient may apply soothing ointments (preparation H, Anusol HC, Lidocaine ointment) after dressing is removed
- Provide follow up in 24-48hr
Complications
See Also
External Links
Videos
{{#widget:YouTube|id=KU1c1JfpJHM}}