Management and Treatment of External Hemorrhoidal Thrombosis

Abstract

BackgroundExternal hemorrhoidal thrombosis (EHT) is a common complication of hemorrhoidal disease. This condition causes extreme pain, likely resulting from internal anal sphincter hypertonicity, which traps the hemorrhoids below the dentate line thus leading to congestion and swelling. The choice of treatment remains controversial and both conservative and surgical options have been proposed in the last decades.MethodsThis mini-review focuses on the most relevant studies found in literature evaluating conservative and surgical management of EHT. Special conditions such as pregnancy and EHT in elderly patients have been considered.ResultsTraditionally, symptoms duration represents the discriminant in the choice between medical and surgical treatment. Several Coloproctological Societies considered conservative treatment as the first-line approach to EHT and a variety of options have been proposed: wait and see, mixture of flavonoids, mix of lidocaine and nifedipine, botulinum toxin injection and topical application of 0.2% glyceryl trinitrate. Meanwhile, different surgical treatments are recommended when EHT fails to respond to conservative management or when symptoms onset falls within the last 48–72 h: drainage with radial incision, conventional excision, excision under local anesthesia and stapled technique.ConclusionThe management and treatment of EHT is still controversial since no specific guidelines have been published. Both medical and surgical treatment have been proven effective but randomized clinical trials and structured consensus-based guidelines are warranted.

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Common design and data elements on rectal artery embolization for treatment of symptomatic internal hemorrhoidal disease: an interactive systematic review of clinical trials

“…They can involve both the anal verge and the first half of the anal canal and are often associated with symptoms like pain, itching, swelling, and the potential formation of painful blood clots (thrombosis).. These distinctions in location and symptoms are crucial in the diagnosis and treatment of hemorrhoids, helping healthcare professionals determine the appropriate management strategies for each patient's specific condition [ 4 ].…”

Comparision of Ligasure hemorrhoidectomy and conservative treatment for thrombosed external hemorrhoids (TEH) in pregnancy

“…Thrombosed external hemorrhoid (TEH) in pregnancy is the manifestation of the acute attack of hemorrhoid due to the increased intra-abdominal pressure from uterine growth, constipation and diarrhea. TEH, can involve both the external and internal hemorrhoidal plexuses, being the first more frequently affected, a certain degree of hypertonicity of the internal anal sphincter may trap the hemorrhoidal mass outside the anus leading to strangulation, necrosis, and gangrene [ 1 – 3 ]. From acutely intense pain, a visible and can’t returning lump, sometimes combine bleeding when thrombosis leads to the necrosis of overlying skin, we can make the correct diagnosis easily.…”