Surgical treatment of thrombosed external hemorrhoids – Case report and review of literature
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Department of Oncology, Faculty of Medical Sciences, University of Warmia and Mazury in Olsztyn, Poland
Department of Surgical Oncology, Ministry of Internal Affairs Hospital with Warmia and Mazury Oncology Centre, Olsztyn, Poland
Department of Public Health, Hygiene and Epidemiology, Faculty of Medical Sciences, University of Warmia and Mazury in Olsztyn, Poland
Department of Oncology and Gynecologic Oncology, Ministry of Internal Affairs Hospital with Warmia and Mazury Oncology Centre, Olsztyn, Poland
Submission date: 2013-02-27
Acceptance date: 2013-07-08
Online publication date: 2013-07-09
Publication date: 2020-04-07
Corresponding author
Konrad Wroński   

Department of Surgical Oncology, Ministry of Internal Affairs Hospital with Warmia and Mazury Oncology Centre, Wojska Polskiego 37, 10-228 Olsztyn, Poland. Tel.: +48 89 539 85 42; fax: +48 89 539 85 41.
Pol. Ann. Med. 2013;20(1):35-38
Although anorectal diseases in clinical practice are relatively common, thrombosed external hemorrhoids (TEH) are still a major therapeutic problem. TEH most frequently occurs in subjects with diagnosed hemorrhoidal disease.

The aim of this work was to report and analyze a case of TEH.

Case study:
The patient, a 22-year-old male, attended Proctology Clinic with a severe anal pain. He had a history of pain which occurred the day before for the first time in his life. Physical examination showed no abnormalities. Digital rectal examination revealed TEH. Patient consented for incision of TEH under local anesthesia. Following the administration of anesthesia around TEH, incision was made and blood clot was evacuated. After 2 days the patient attended a follow-up appointment in the Proctology Clinic. After the incision was made the pain has resolved. From the time of TEH incision the patient did not receive any pain medication. After 5 months there was no recurrence of the disease.

Results and discussion:
TEH is the cause of severe pain and itching. Major cause of the pain is the increased tension of external anal sphincter muscle. Diagnosis of TEH is made based on anamnesis, physical examination and additional tests. The most important part of a physical examination is digital rectal examination. Early diagnosis of thrombus and initiation of proper, most frequently surgical, treatment is an effective treatment method of this condition.

Treatment of TEH should be adjusted for each patient individually. The main factor determining the choice of treatment method is patient consent for a surgical intervention under local anesthesia. Excision or incision of the thrombosed hemorrhoid under local anesthesia in patients with TEH is a completely secure method, at the same time with a low number of complications.

None declared.
Johanson JF, Sonnenberg A. The prevalence of hemorrhoids and chronic constipation. An epidemiologic study. Gastroenterology. 1990;98(2):380–386.
Hulme-Moir M, Bartolo DC. Hemorrhoids. Gastroenterol Clin North Am. 2001;30(1):183–197.
Thomson WH. The nature of haemorrhoids. Br J Surg. 1975;62 (7):542–552.
Shafik A. Role of warm-water bath in anorectal conditions. The “thermosphincteric reflex.” J Clin Gastroenterol. 1993;16(4):304–308.
Alonso-Coello P, Mills E, Heels-Ansdell D, López-Yarto M, Zhou Q, Johanson JF, et al. Fiber for the treatment of hemorrhoids complication: a systematic review and meta-analysis. Am J Gastroenterol. 2006;101(1):181–188.
Abramowitz L, Sobhani I, Benifla JL, Vuagnat A, Daraï E, Mignon M, et al. Anal fissure and thrombosed external hemorrhoids before and after delivery. Dis Colon Rectum. 2002;45(5):650–655.
Greenspon J, Williams SB, Young HA, Orkin BA. Thrombosed external hemorrhoids: outcome after conservative or surgical management. Dis Colon Rectum. 2004;47(9):1493–1498.
Grosz CR. A surgical treatment of thrombosed external hemorrhoids. Dis Colon Rectum. 1990;33(3):249–250.
Jongen J, Bach S, Stübinger SH, Bock JU. Excision of thrombosed external hemorrhoid under local anesthesia. A retrospective evaluation of 340 patients. Dis Colon Rectum. 2003;46:1226–1231.
Zuber TJ. Hemorrhoidectomy for thrombosed external hemorrhoids. Am Fam Physician. 2002;65(8):1629–1632.
Hancock B. ABC of colorectal diseases. Haemorrhoids. Br Med J. 1992;304(6833):1042–1044.
Oh C. Acute thrombosed external hemorrhoids. Mt Sinai J Med. 1989;56(1):30–32.
Patti R, Arcara M, Bonaventre S, Sommartano S, Sparacello M, Vitello G, et al. Randomized clinical trial of botulinum toxin injection for pain relief in patients with thrombosed external hemorrhoids. Br J Surg. 2008;95(11):1339–1343.
Gebbensleben O, Hilger Y, Rohde H. Aetiology of thrombosed external haemorrhoids: a questionnaire study. BMC Res Notes. 2009;2:216.
Perrotti P, Antropoli C, Molino D, De Stefano G, Antropoli M. Conservative treatment of acute thrombosed external hemorrhoids with topical nifedipine. Dis Colon Rectum. 2001;44(3):405–409.
Eisenstat T, Salvati EP, Rubin RJ. The outpatient management of acute hemorrhoidal disease. Dis Colon Rectum. 1979;22(5):315–317.
Delaini GG, Bortolasi L, Falezza G, Barbosa A. Trombosi emorroidaria ed ematoma perianale: diagnosi e trattamento [Hemorrhoidal thrombosis and perianal hematoma: diagnosis and treatment]. Ann Ital Chir. 1995;66(6):783–785 [in Italian].
Arthur KE. Hematoma anal (saculo venoso coagulado o trombosis peri-anal) [Anal hematoma (coagulated venous succule or peri-anal thrombosis)]. Rev Med Panama. 1990;15(1):31–34 [in Spanish].
Brearly S, Brearly R. Perianal thrombosis. Dis Colon Rectum. 1988;31:403–404.
Thomson H. The real nature of “perianal haematoma.” Lancet. 1982;2(8296):467–468.
Kuehn HG, Gebbensleben O, Hilger Y, Rohde H. Relationship between anal symptoms and anal findings. Int J Med Sci. 2009;6(2):77–84.
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