SAQ 279 – General Surgery – thrombosed external haemorrhoid management

General Surgery – thrombosed external haemorrhoid management.

a. Conservative management

• Symptoms present for more than 48 hours.
• Pain is controlled and not severe.
• Haemorrhoid is small or not bulging under tension.
• Already retracting or resolving.
• Any high-risk feature that makes excision unsuitable.

b. Excision contraindications

• Pregnancy.
• Immunocompromise.
• Portal hypertension or coagulopathy.
• Anterior or posterior midline lesion.
• Multiple external haemorrhoids.
• Inflammatory bowel disease.
• Unsuitable for sedation, local-anaesthetic allergy, clinician lacks skill, or department workload is unsafe.

c. Procedure

• Position prone, lateral decubitus, or lithotomy.
• Provide analgesia with or without procedural sedation.
• Prepare and sterilise the skin, then perform a local-anaesthetic field block.
• Make an elliptical radial incision and excise skin/clot or evacuate the clot.
• Pack or leave to granulate and apply an absorbent dressing.