External hemorrhoid excision: Difference between revisions
(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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==Procedure== | ==Procedure== | ||
#Place pt in side-lying or prone position | #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 | ##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 | #Make elliptical incision in overlying skin to expose the thrombosis | ||
##Remove the clot and the overlying skin through the incision site | ##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 | #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 | ##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 | |||
#Provide f/u in 24-48hr | #Provide f/u in 24-48hr | ||
| Line 31: | Line 33: | ||
#Fistula | #Fistula | ||
#Abscess | #Abscess | ||
#Skin tags | |||
==See Also== | ==See Also== | ||
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==Source== | ==Source== | ||
Tintinalli | Tintinalli | ||
Robert and Hedges | |||
[[Category:Procedures]] | [[Category:Procedures]] | ||
Revision as of 04:28, 8 January 2013
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
See Also
Source
Tintinalli Robert and Hedges