Answer
Acute pain and thrombosis of an external hemorrhoid within 48-72 hours of onset is an indication for excision.
In a retrospective study by Greenspon et al, surgical treatment resulted in much faster symptom resolution (3.9 days vs 24 days), as well as a lower frequency of recurrence (6.3% vs 25.4%), in the study population. [13] A study by Cavcić et al demonstrated that in comparison with simple incision or topically applied 0.2% glycerin trinitrate ointment, thrombosed external hemorrhoid excision improved recurrence rates, symptoms, and residual skin tags at 1-year follow-up. [14]
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Media Gallery
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Excision of thrombosed external hemorrhoid. Taping of patient before procedure (thrombosed external hemorrhoid is at 9-o'clock position).
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Excision of thrombosed external hemorrhoid. Preparation of light source for sterile field.
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Excision of thrombosed external hemorrhoid. Injection of local anesthetic at hemorrhoid base and within hemorrhoid.
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Excision of thrombosed external hemorrhoid. Application of povidone-iodine antiseptic.
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Excision of thrombosed external hemorrhoid. Primary elliptical incision over hemorrhoid.
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Excision of thrombosed external hemorrhoid. Further incision with removal of clot.
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Excision of thrombosed external hemorrhoid. Gauze packing after procedure.
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Excision of thrombosed external hemorrhoid. Dressing after excision.
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Excision of thrombosed external hemorrhoid. Dressing after excision.
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Thrombosed hemorrhoid, treated with incision and removal of clot. Image courtesy of Dr. Jonathan Adler.
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Anatomy of external hemorrhoid. Image courtesy of MedicineNet, Inc.
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