Thrombosed external hemorrhoids often occurs in grade III-IV internal hemorrhoids, and can cause excruciating pain, and patients will often present acutely. In such cases, surgical evacuation of the hemorrhoid can produce immediate relief.
The treatment of choice is hemorrhoidectomy with partial lateral internal sphincterotomy, which consists in incised the mucosa on each side of the hemorrhoid and extended outward toward the anoderm. The anoderm and the hemorrhoidal mass are elevated off the transverse fibers of the internal sphincter muscle. Then the mucosa is approximated with continuous 3-0 absorbable sutures, leaving 2 to 3 mm of the anoderm left open for drainage.
Jon Mikel IÃ±arritu, M.D.
Link to: Hemorrhoidal Prolapse