External hemorrhoid excision

Revision as of 18:00, 2 August 2011 by Jswartz (talk | contribs) (Created page with "==Indications== #Thrombosis is acute (<48 hr) #Extremely painful ==Contraindications== #Immunocompromise #Child #Pregnant woman #Portal HTN #Coagulopathy ==Equipment Needed== #...")
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Indications

  1. Thrombosis is acute (<48 hr)
  2. Extremely painful

Contraindications

  1. Immunocompromise
  2. Child
  3. Pregnant woman
  4. Portal HTN
  5. Coagulopathy

Equipment Needed

  1. Scalpel
  2. Local anesthetic

Procedure

  1. Place pt in side-lying or prone position
    1. Apply tape to each buttock with force directed laterally for better visualization
  2. Apply local anesthetic (e.g. bupivacaine 0.5% w/ epi) w/ 30-gauge needle
  3. Make elliptical incision in overlying skin to expose the thrombosis
    1. Remove the clot and the overlying skin through the incision site
  4. Control bleeding by tucking corner of a small piece of gauze into the wound
    1. Leave in place for a few hours
  5. Apply pressure dressing have pt remove 6-12 hr later when takes first stiz bath
  6. Provide f/u in 24-48hr

Complications

  1. Continued bleeding
  2. Recurrence
  3. Infection
  4. Fistula
  5. Abscess

See Also

Anorectal Disorders

Source

Tintinalli

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