External hemorrhoid excision: Difference between revisions
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==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 | ||
Revision as of 16:29, 10 October 2018
Indications
- Acute (<72 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 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
- Continued bleeding
- Recurrence
- Infection
- Fistula
- Abscess
- Skin tags