External hemorrhoid excision

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
2. Apply EMLA 1 hr prior to procedure
   1. Apply tape to each buttock with force directed laterally for better visualization
3. Inject local anesthetic (e.g. bupivacaine 0.5% w/ epi) w/ 30-gauge needle directly into dome of hemorrhoid as a single injection
4. Make elliptical incision in overlying skin to expose the thrombosis
   1. Remove the clot and the overlying skin through the incision site
5. Control bleeding by tucking corner of a small piece of gauze into the wound and tape buttocks together
   1. Leave in place for a few hours
6. Apply pressure dressing have pt remove 6-12 hr later when takes first stiz bath
7. Patient may apply soothing ointments (preparation H, Anusol HC, Lidocaine ointment)after dressing is removed
8. Provide f/u in 24-48hr

Complications

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

See Also

Anorectal Disorders

Source

Tintinalli Robert and Hedges