External hemorrhoid excision: Difference between revisions
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==Contraindications== | ==Contraindications== | ||
*Immunocompromise | |||
*Child | |||
*Pregnant woman | |||
*Portal HTN | |||
*Coagulopathy | |||
==Equipment Needed== | ==Equipment Needed== | ||
*Scalpel | |||
*Local anesthetic | |||
==Procedure== | ==Procedure== | ||
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==Complications== | ==Complications== | ||
*Continued bleeding | |||
*Recurrence | |||
*Infection | |||
*Fistula | |||
*Abscess | |||
*Skin tags | |||
==See Also== | ==See Also== | ||
Revision as of 11:57, 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