Gastroenterology Book

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Thrombosed External Hemorrhoid

Aka: Thrombosed External Hemorrhoid, Thrombosed Hemorrhoid
  1. See Also
    1. Hemorrhoid
    2. External Hemorrhoid
    3. Thrombosed Hemorrhoidectomy
  2. Pathophysiology
    1. Complication of External Hemorrhoid
    2. May follow sudden episode of increased anal pressure
      1. Coughing, sneezing, lifting or Defecation
  3. Symptoms
    1. Severe Anorectal Pain
    2. Exascerbated by sitting, standing, or defecating
  4. Signs
    1. Tender and inflammed External Hemorrhoid
    2. Hemorrhoid is tense, firm with underlying bluish clot
  5. Management
    1. See Hemorrhoid Management for general measures
    2. See Thrombosed Hemorrhoidectomy (if <72 hours)
    3. Topical Nifedipine 0.3% and Lidocaine 1.5% ointment
      1. Apply twice daily for 1-2 weeks for analgesia
  6. Course
    1. Resolves in days to weeks regardless of surgery
    2. Surgical excision within 72 hours shortens course
  7. References
    1. Pickard in Dornbrand (1992) Ambulatory Care, p. 226
    2. Hulme-Moir (2001) Gastroenterol Clin North Am 30:183-97
    3. Hussain (1999) Prim Care 26(1):35-51

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