External hemorrhoid excision: Difference between revisions
| Line 25: | Line 25: | ||
#*Leave in place for a few hours | #*Leave in place for a few hours | ||
#Apply pressure dressing have patient remove 6-12 hr later when takes first stiz bath | #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 | #Patient may apply soothing ointments (preparation H, Anusol HC, [[Lidocaine]] ointment) after dressing is removed | ||
#Provide follow up in 24-48hr | #Provide follow up in 24-48hr | ||
Revision as of 12:22, 14 February 2017
Indications
- Acute (<48 hours) thrombosed 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 EMLA 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
- Continued bleeding
- Recurrence
- Infection
- Fistula
- Abscess
- Skin tags