External hemorrhoid excision: Difference between revisions
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#Place pt in side-lying or prone position | #Place pt in side-lying or prone position | ||
#Apply EMLA 1 hr prior to procedure | #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% w/ epi) w/ 30-gauge needle directly into dome of hemorrhoid as a ''single'' injection | #Inject local anesthetic (e.g. bupivacaine 0.5% w/ epi) w/ 30-gauge needle directly into dome of hemorrhoid as a ''single'' injection | ||
#Make elliptical incision in overlying skin to expose the thrombosis | #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 | #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 pt remove 6-12 hr later when takes first stiz bath | #Apply pressure dressing have pt 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 | ||
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[[Anorectal Disorders]] | [[Anorectal Disorders]] | ||
== | ==References== | ||
[[Category:Procedures]] | [[Category:Procedures]] | ||
Revision as of 11:56, 10 June 2015
Indications
- Thrombosis is acute (<48 hr)
- Extremely painful
Contraindications
- Immunocompromise
- Child
- Pregnant woman
- Portal HTN
- Coagulopathy
Equipment Needed
- Scalpel
- Local anesthetic
Procedure
- Place pt 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% w/ epi) w/ 30-gauge needle directly into dome of hemorrhoid as a single injection
- 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 pt 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 f/u in 24-48hr
Complications
- Continued bleeding
- Recurrence
- Infection
- Fistula
- Abscess
- Skin tags