External hemorrhoid excision: Difference between revisions
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==Indications== | ==Indications== | ||
* | *Acute (<72 hours) thrombosed [[external hemorrhoid]] | ||
* | *Pain/discomfort affects daily life | ||
==Contraindications== | ==Contraindications== | ||
* | *Immunocompromised patient | ||
* | *Pediatric patient | ||
*Pregnant | *Pregnant patient | ||
*Portal | *Portal hypertension | ||
*Coagulopathy | *Coagulopathy | ||
| Line 15: | Line 15: | ||
==Procedure== | ==Procedure== | ||
#Place | #Place patient in side-lying or prone position | ||
#Apply | #Apply lidocaine/prilocaine cream 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% | #Inject local anesthetic (e.g. [[bupivacaine]] 0.5% with epi) with 30-gauge needle directly into dome of hemorrhoid as a ''single'' injection | ||
#*Alternatively, a [[perianal block]] can be used for local analgesia | |||
#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 and tape buttocks together | #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 | #Apply pressure dressing have patient 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 | #Patient may apply soothing ointments (preparation H, Anusol HC, [[Lidocaine]] ointment) after dressing is removed | ||
#Provide | #Provide follow up in 24-48hr | ||
==Complications== | ==Complications== | ||
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*Recurrence | *Recurrence | ||
*Infection | *Infection | ||
*Fistula | *[[anal fistula|Fistula]] | ||
*Abscess | *[[perianal Abscess|Abscess]] | ||
*Skin tags | *[[anal tags|Skin tags]] | ||
==See Also== | ==See Also== | ||
*[[Hemorrhoids]] | *[[Hemorrhoids]] | ||
*[[Anorectal disorders]] | |||
*[[Internal hemorrhoid]] | |||
*[[External hemorrhoid]] | |||
==External Links== | |||
*[https://www.merckmanuals.com/professional/gastrointestinal-disorders/anorectal-disorders/hemorrhoids?query=external%20hemorrhoid Merk Manual - How To Do Hemorrhoidal Thrombectomy] | |||
===Videos=== | |||
{{#widget:YouTube|id=KU1c1JfpJHM}} | |||
==References== | ==References== | ||
<references/> | |||
[[Category:Procedures]] | [[Category:Procedures]] | ||
[[Category:GI]] | |||
Latest revision as of 00:30, 16 July 2021
Indications
- Acute (<72 hours) thrombosed external hemorrhoid
- Pain/discomfort affects daily life
Contraindications
- Immunocompromised patient
- Pediatric patient
- Pregnant patient
- Portal hypertension
- Coagulopathy
Equipment Needed
- Scalpel
- Local anesthetic
Procedure
- Place patient in side-lying or prone position
- Apply lidocaine/prilocaine cream 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% with epi) with 30-gauge needle directly into dome of hemorrhoid as a single injection
- Alternatively, a perianal block can be used for local analgesia
- 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 patient 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 follow up in 24-48hr
Complications
See Also
External Links
Videos
{{#widget:YouTube|id=KU1c1JfpJHM}}