Incision of Thrombosed Hemorrhoid, External

Common Name(s): Hemorrhoid thrombectomy, Hemorrhoid incision, Excision of thrombosed external hemorrhoid

Summary

An incision of a thrombosed external hemorrhoid involves making a small cut in a swollen vein near the anus to remove a blood clot, relieving pain and pressure.

Purpose

This procedure addresses thrombosed external hemorrhoids, which are swollen veins in the lower rectum that have formed blood clots. The goal is to alleviate severe pain, reduce swelling, and prevent further complications.

Indications

• Severe pain and swelling around the anus due to a thrombosed hemorrhoid
• Visible external hemorrhoid with a firm, blueish lump
• Inability to sit or move comfortably
• Significant discomfort not relieved by conservative treatment (e.g., creams, warm baths)

Preparation

• Patients may need to avoid eating or drinking for a few hours prior if anesthesia will be used.
• Patients should inform their doctor of any medications or conditions.
• A pre-procedure assessment to ensure no active infections or severe health issues.

Procedure Description

1. The patient is positioned to expose the hemorrhoid (typically lying on their side).
2. Local anesthesia is applied to numb the area.
3. A small incision is made over the hemorrhoid to drain the clot.
4. The clot is carefully removed, and the area is cleaned.
5. The incision may be left open to heal naturally or lightly packed with gauze.

Tools Used: Scalpel, surgical scissors, gauze, antiseptic solutions.

Anesthesia: Local anesthesia is commonly applied to minimize pain during the procedure.

Duration

The procedure typically takes about 15-30 minutes.

Setting

Performed in an outpatient clinic, a doctor's office, or a minor procedure room within a hospital.

Personnel

• A general surgeon or a colorectal specialist
• A nurse or medical assistant

Risks and Complications

• Common risks: Bleeding, infection, temporary pain.
• Rare risks: Recurrence, damage to surrounding tissues, allergic reactions to anesthesia.
• Management includes antibiotics for infections and pain management strategies.

Benefits

• Immediate relief from severe pain and pressure.
• Rapid reduction in swelling and discomfort.
• Return to normal activities within a few days.

Recovery

• Patients may be advised to take sitz baths several times a day.
• Pain management with prescribed or over-the-counter pain relievers.
• Applying ice packs to reduce swelling.
• Recovery time typically spans a few days to a week.
• Follow-up appointments to monitor healing and check for recurrence.

Alternatives

• Conservative management with dietary changes, topical treatments, and pain relief.
• Rubber band ligation for internal hemorrhoids.
• Sclerotherapy or infrared coagulation for other hemorrhoid types.

Pros of alternatives: Less invasive, lower immediate risk.

Cons of alternatives: Slower relief, potentially less effective for severe cases.

Patient Experience

• During: The procedure itself is usually quick and should not be painful due to local anesthesia; some pressure or mild discomfort may be felt.
• After: Mild to moderate pain managed by medications; soreness and swelling are normal and will subside.
• Pain management includes medications and comfort measures such as warm baths and ice packs.