Download PDF
Clin Colon Rectal Surg 2024; 37(06): 381-386
DOI: 10.1055/s-0043-1777663
Review Article

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

Ayman Khan
1   Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
,
Arielle E. Kanters
1   Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

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


Publication History

Article published online:
28 December 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Sun Z, Migaly J. Review of hemorrhoid disease: presentation and management. Clin Colon Rectal Surg 2016; 29 (01) 22-29
    Thieme ConnectPubMedSearch in Google Scholar
  • 2 Bohl JL, Saleeby RG, Herline AJ. Acute hemorrhoidal crisis. Sem Colon Rectal Surg 2007; 18 (03) 197-201
    CrossrefPubMedSearch in Google Scholar
  • 3 Kaidar-Person O, Person B, Wexner SD. Hemorrhoidal disease: a comprehensive review. J Am Coll Surg 2007; 204 (01) 102-117
    CrossrefPubMedSearch in Google Scholar
  • 4 Lohsiriwat V. Anorectal emergencies. World J Gastroenterol 2016; 22 (26) 5867-5878
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 9 Eu KW, Seow-Choen F, Goh HS. Comparison of emergency and elective haemorrhoidectomy. Br J Surg 1994; 81 (02) 308-310
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 13 Ferguson JA, Heaton JR. Closed hemorrhoidectomy. Dis Colon Rectum 1959; 2 (02) 176-179
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 16 De la Garza M, Counihan TC. Complications of hemorrhoid surgery. Semin Colon Rectal Surg 2013; 24: 96-102
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 20 Wald A. Constipation, diarrhea, and symptomatic hemorrhoids during pregnancy. Gastroenterol Clin North Am 2003; 32 (01) 309-322 , vii
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 22 Avsar AF, Keskin HL. Haemorrhoids during pregnancy. J Obstet Gynaecol 2010; 30 (03) 231-237
    CrossrefPubMedSearch in Google Scholar