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 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== | ||
Revision as of 16:10, 9 October 2019
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