Analvenenthrombose und thrombosierter Hämorrhoidalprolaps^[*]

Zusammenfassung

Die Analvenenthrombose (AVT) ist der häufigste proktologische Notfall. Im Bereich der sensiblen Anokutanlinie entsteht ein bläulicher Knoten (Hämatom bzw. Thrombose). Differenzialdiagnostisch muss die AVT von dem thrombosierten Anal- und Hämorrhoidalprolaps (THP) unterschieden werden. Beide Läsionen können Schmerzen auslösen. Bei dem THP inkarzeriert und thrombosiert prolabierendes Hämorrhoidalgewebe und es handelt sich somit eine Komplikation von Hämorrhoiden 2., 3. und 4. Grades. Die AVT kann bei entsprechenden Beschwerden exzidiert werden, während beim THP in diesem Falle eine Hämorrhoidektomie notwendig wird. Bei beiden Läsionen ist das Vorgehen eher konservativ: lokale Kühlung und/oder kortikoidhaltige Salbe, systemisch: ein nicht-steroidales Antirheumatikum. Bei der AVT ist bei starken Schmerzen oder Blutungen nach Perforation eher eine Exzision zu erwägen. Nach einer Inzision könnte die Stelle verkleben und es kann durch nachlaufendes Blut zu einem „Rezidiv“ kommen.

Abstract

Perianal haematoma/thrombosis (AH) is a common anorectal emergency: on the anal verge a blue lump is situated. It should be differentiated from thrombosed (external) haemorrhoidal prolapse (THP). Both lesions might cause considerable pain. THP is caused by prolapsing haemorrhoidal tissue complicated by incarceration and thrombosis.

AH might be excised, the excision of a THP is a regular haemorrhoidectomy. Therefore conservative therapy of THP is preferred: cooling, local steroid ointment and/or a non-steroidal anti-inflammatory drug (NSAID). Most AH (about 60 – 70 %) can be treated similarly. If pain and bleeding after perforation are eminent, excision of the AH might be performed. Incision of AH is not recommended, because the incision might adhere and the AH might recur.

^* Dieser Artikel ist eine aktualisierte Form von Jongen J, Feeser K, Schumacher J, Peleikis H-G, Kahlke V. Analvenenthrombose und thrombosierter Hämorrhoidalprolaps. Verdauungskrankheiten 2015; 33: 68 – 76.

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