Management of Acute Hemorrhoidal Crisis: Evaluation, Treatment, and Special Considerations

Abstract

Hemorrhoidal disease is one of most common pathologies seen by colorectal and general surgeons. Although hemorrhoids themselves are a normal anatomic occurrence, development of symptomatic disease, usually due to bleeding, prolapse, or thrombosis, can cause significant patient distress. Acute presentation related to significant thrombosis or bleeding is referred to as acute hemorrhoidal crisis. Management of this pathology varies from nonoperative intervention for symptom control to definitive incisional or excisional hemorrhoidectomy. Here we will explore the approach to evaluating and treating acute hemorrhoidal crises.

Keywords

hemorrhoid - hemorrhoidal crisis - thrombosed hemorrhoids

Publikationsverlauf

Artikel online veröffentlicht:
28. Dezember 2023

• References

• 1 Sun Z, Migaly J. Review of hemorrhoid disease: presentation and management. Clin Colon Rectal Surg 2016; 29 (01) 22-29
• 2 Bohl JL, Saleeby RG, Herline AJ. Acute hemorrhoidal crisis. Sem Colon Rectal Surg 2007; 18 (03) 197-201
• 3 Kaidar-Person O, Person B, Wexner SD. Hemorrhoidal disease: a comprehensive review. J Am Coll Surg 2007; 204 (01) 102-117
• 4 Lohsiriwat V. Anorectal emergencies. World J Gastroenterol 2016; 22 (26) 5867-5878
• 5 Jongen J, Bach S, Stübinger SH, Bock JU. Excision of thrombosed external hemorrhoid under local anesthesia: a retrospective evaluation of 340 patients. Dis Colon Rectum 2003; 46 (09) 1226-1231
• 6 Allan A, Samad AJ, Mellon A, Marshall T. Prospective randomised study of urgent haemorrhoidectomy compared with non-operative treatment in the management of prolapsed thrombosed internal haemorrhoids. Colorectal Dis 2006; 8 (01) 41-45
• 7 Greenspon J, Williams SB, Young HA, Orkin BA. Thrombosed external hemorrhoids: outcome after conservative or surgical management. Dis Colon Rectum 2004; 47 (09) 1493-1498
• 8 Cavcić J, Turcić J, Martinac P, Mestrović T, Mladina R, Pezerović-Panijan R. Comparison of topically applied 0.2% glyceryl trinitrate ointment, incision and excision in the treatment of perianal thrombosis. Dig Liver Dis 2001; 33 (04) 335-340
• 9 Eu KW, Seow-Choen F, Goh HS. Comparison of emergency and elective haemorrhoidectomy. Br J Surg 1994; 81 (02) 308-310
• 10 Ceulemans R, Creve U, Van Hee R, Martens C, Wuyts FL. Benefit of emergency haemorrhoidectomy: a comparison with results after elective operations. Eur J Surg 2000; 166 (10) 808-812 , discussion 813
• 11 Davis BR, Lee-Kong SA, Migaly J, Feingold DL, Steele SR. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of hemorrhoids. Dis Colon Rectum 2018; 61 (03) 284-292
• 12 Milligan ETC, Naunton Morgan C, Jones L. et al. Surgical anatomy of the anal canal, and the operative treatment of hæmorrhoids. Lancet 1937; 230: 1119-1124
• 13 Ferguson JA, Heaton JR. Closed hemorrhoidectomy. Dis Colon Rectum 1959; 2 (02) 176-179
• 14 Bhatti MI, Sajid MS, Baig MK. Milligan–Morgan (open) versus Ferguson haemorrhoidectomy (closed): a systematic review and meta-analysis of published randomized, controlled trials. World J Surg 2016; 40 (06) 1509-1519
• 15 Balciscueta Z, Balciscueta I, Uribe N. Post-hemorrhoidectomy pain: can surgeons reduce it? A systematic review and network meta-analysis of randomized trials. Int J Colorectal Dis 2021; 36 (12) 2553-2566
• 16 De la Garza M, Counihan TC. Complications of hemorrhoid surgery. Semin Colon Rectal Surg 2013; 24: 96-102
• 17 Brown SR, Tiernan JP, Watson AJM. et al; HubBLe Study team. Haemorrhoidal artery ligation versus rubber band ligation for the management of symptomatic second-degree and third-degree haemorrhoids (HubBLe): a multicentre, open-label, randomised controlled trial. Lancet 2016; 388 (10042): 356-364
• 18 Pucher PH, Sodergren MH, Lord AC, Darzi A, Ziprin P. Clinical outcome following Doppler-guided haemorrhoidal artery ligation: a systematic review. Colorectal Dis 2013; 15 (06) e284-e294
• 19 Medich DS, Fazio VW. Hemorrhoids, anal fissure, and carcinoma of the colon, rectum, and anus during pregnancy. Surg Clin North Am 1995; 75 (01) 77-88
• 20 Wald A. Constipation, diarrhea, and symptomatic hemorrhoids during pregnancy. Gastroenterol Clin North Am 2003; 32 (01) 309-322 , vii
• 21 Abramowitz L, Sobhani I, Benifla JL. et al. Anal fissure and thrombosed external hemorrhoids before and after delivery. Dis Colon Rectum 2002; 45 (05) 650-655
• 22 Avsar AF, Keskin HL. Haemorrhoids during pregnancy. J Obstet Gynaecol 2010; 30 (03) 231-237