A Surgical Treatment of Thrombosed External Hemorrhoids CARL R. GROSZ, M.D.
Grosz CR. A surgical treatment of thrombosed external hemorrhoids. Dis Colon Rectum 1990;33:249-250. An anatomically based method for the surgical treatment of thrombosed external hemorrhoids has been described. It involves a circumferential incision over the thrombosed hemorrhoidal sinus and removes the thrombi from involved veins. [Key words: Hemorrhoid, external; Hemorrhoid, thrombosed; Surgical technique]
A THROMBOSED EXTERNAL h e m o r r h o i d is a small, c o m m o n problem that causes severe p a i n and disability, but "more than a little is by m u c h too much. ''a Most physicians or surgeons are familiar with the condition and encounter it frequently. If the thrombosis is n o t large and is over 48 hours in duration, conservative therapy often suffices, however, if the thrombosis is less than 48 hours old or is large, surgical removal of the thrombosis results in rapid relief and cure. There are two putative methods of surgical therapy for thrombosed external hemorrhoids. One is drainage with a radial incision (Fig. 1) and the other is complete excision of the offending h e m o r r h o i d 2 -6 A third method based on anatomic considerations is described. Technique
With the patient on a proctoscopic table and with the h e m o r r h o i d exposed, the area is prepared with Address reprint requests to Dr. Grosz:6030Emerald St., Boise, Idaho 83704.
249
From St. A lphonsus Regional Medical Center, and St. Luke's Regional Medical Center, Boise, Idaho
p o v i d o n e - i o d i n e a n d the skin o v e r the h e m o r r h o i d is injected with a local anesthetic. An incision, which is circumferential in relation to the anus, is made and it need be only about 1 cm in length (Fig. 2). T h i s usually results in several clots being released from the thrombosed hemorrhoidal sinus and occasionally one large clot. W h e n the thrombi are removed in this manner, the incision heals promptly, generally without a skin tag.
Discussion
T h e external hemorrhoids are not composed of single veins, but each one is a plexus of veins.Y, s When there is a thrombosis, there are generally multiple clots. A radial incision m a y open only one or two veins and leave several t h r o m b i in place, and the patient continues to have symptoms. T h e thrombosis m a y involve a large portion of the circumference of the anus and total excision m a y result in a large w o u n d that heals slowly. T h e proposed circumferential incision opens across the plexus and removes the clots from all the veins without leaving a large wound.
250
Dis. Col. ~ Rect.
CARL R. GROSZ
March 1990
//,//~,",,s,,~//fffff"-~-~
!
FIG. 1. Radial incision; only one or two veins are opened, leaving several thrombi in place.
References 1. Shakespeare W. Henry IV, act llI, scene 11, line 71. 2. Cooper P. The craft of surgery. Boston: Little, Brown, 1964:1259. 3. Corman ML. Colon and rectal surgery. Philadelphia: JB Lippincott, 1984:56-7. 4. Goligher JC. Surgery of the anus, rectum, and colon. London: Bailliere Tindall, 1984:143-4.
.,
FIG. 2. Circumferential incision; opens across plexus and removes clots from all veins without leaving a large wound.
5. Jackman RJ. The management of hemorrhoidal thrombosis. GP 1956;:82-3. 6. Shackelford RT. Surgery of the alimentary tract. Philadelphia: WB Saunders, 1955:1768. 7. Berk JE, ed. Bockus gastroenterology. Philadelphia: WB Saunders, 1985;2600. 8. Goss CM, ed. Gray's anatomy of the h u m a n body. Philadelphia: Lea & Febiger, 1973:1244.
Grosz CR. A surgical treatment of thrombosed external hemorrhoids. Dis Colon Rectum 1990;33:249-250. An anatomically based method for the surgical treatment of thrombosed external hemorrhoids has been described. It involves a circumferential incision over the thrombosed hemorrhoidal sinus and removes the thrombi from involved veins. [Key words: Hemorrhoid, external; Hemorrhoid, thrombosed; Surgical technique]
A THROMBOSED EXTERNAL h e m o r r h o i d is a small, c o m m o n problem that causes severe p a i n and disability, but "more than a little is by m u c h too much. ''a Most physicians or surgeons are familiar with the condition and encounter it frequently. If the thrombosis is n o t large and is over 48 hours in duration, conservative therapy often suffices, however, if the thrombosis is less than 48 hours old or is large, surgical removal of the thrombosis results in rapid relief and cure. There are two putative methods of surgical therapy for thrombosed external hemorrhoids. One is drainage with a radial incision (Fig. 1) and the other is complete excision of the offending h e m o r r h o i d 2 -6 A third method based on anatomic considerations is described. Technique
With the patient on a proctoscopic table and with the h e m o r r h o i d exposed, the area is prepared with Address reprint requests to Dr. Grosz:6030Emerald St., Boise, Idaho 83704.
249
From St. A lphonsus Regional Medical Center, and St. Luke's Regional Medical Center, Boise, Idaho
p o v i d o n e - i o d i n e a n d the skin o v e r the h e m o r r h o i d is injected with a local anesthetic. An incision, which is circumferential in relation to the anus, is made and it need be only about 1 cm in length (Fig. 2). T h i s usually results in several clots being released from the thrombosed hemorrhoidal sinus and occasionally one large clot. W h e n the thrombi are removed in this manner, the incision heals promptly, generally without a skin tag.
Discussion
T h e external hemorrhoids are not composed of single veins, but each one is a plexus of veins.Y, s When there is a thrombosis, there are generally multiple clots. A radial incision m a y open only one or two veins and leave several t h r o m b i in place, and the patient continues to have symptoms. T h e thrombosis m a y involve a large portion of the circumference of the anus and total excision m a y result in a large w o u n d that heals slowly. T h e proposed circumferential incision opens across the plexus and removes the clots from all the veins without leaving a large wound.
250
Dis. Col. ~ Rect.
CARL R. GROSZ
March 1990
//,//~,",,s,,~//fffff"-~-~
!
FIG. 1. Radial incision; only one or two veins are opened, leaving several thrombi in place.
References 1. Shakespeare W. Henry IV, act llI, scene 11, line 71. 2. Cooper P. The craft of surgery. Boston: Little, Brown, 1964:1259. 3. Corman ML. Colon and rectal surgery. Philadelphia: JB Lippincott, 1984:56-7. 4. Goligher JC. Surgery of the anus, rectum, and colon. London: Bailliere Tindall, 1984:143-4.
.,
FIG. 2. Circumferential incision; opens across plexus and removes clots from all veins without leaving a large wound.
5. Jackman RJ. The management of hemorrhoidal thrombosis. GP 1956;:82-3. 6. Shackelford RT. Surgery of the alimentary tract. Philadelphia: WB Saunders, 1955:1768. 7. Berk JE, ed. Bockus gastroenterology. Philadelphia: WB Saunders, 1985;2600. 8. Goss CM, ed. Gray's anatomy of the h u m a n body. Philadelphia: Lea & Febiger, 1973:1244.
