Give a definition.
A thrombus within the inferior hemorrhoidal venous plexus distal to the dentate line
Describe the pathophysiology.
Stasis of blood within the external hemorrhoid → thrombus formation → inflammation and distention of the overlying perianal skin → severe pain
External hemorrhoids are located distal to the dentate (pectinate) line and are drained by the inferior hemorrhoidal (rectal) plexus. External hemorrhoid thrombosis occurs if a clot forms in the inferior hemorrhoidal plexus.
List clinical features.
Acute onset of severe perianal pain
Painful perianal mass that may ulcerate and bleed
Painful defecation
List diagnostics.
Typically a clinical diagnosis
Perianal examination: a palpable, tender, dark red to purplish nodule at the anal verge or just within the anal canal
Describe the management.
Surgical excision
Indication: severe, acute perianal pain (< 3–4 days duration)
Medical management
Indications
Patients who present after > 3–4 days of symptom onset
An alternative to surgery in patients with mild or moderate symptoms who present early
Methods
Analgesia: warm sitz baths , antispasmodic agents (e.g., topical nitroglycerin or nifedipine) , analgesic creams (e.g., lidocaine)
Topical antiinflammatories: e.g., hydrocortisone cream
Improve passage of stool: stool softeners (e.g., docusate), increased intake of fluids and fiber
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