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
   • 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
   • 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
   • 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