Management and Treatment of External Hemorrhoidal Thrombosis.
external hemorrhoidal thrombosis
hemorrhoidal disease
hemorrhoidectomy
pregnancy
surgery
Journal
Frontiers in surgery
ISSN: 2296-875X
Titre abrégé: Front Surg
Pays: Switzerland
ID NLM: 101645127
Informations de publication
Date de publication:
2022
2022
Historique:
received:
17
03
2022
accepted:
13
04
2022
entrez:
20
5
2022
pubmed:
21
5
2022
medline:
21
5
2022
Statut:
epublish
Résumé
External hemorrhoidal thrombosis (EHT) is a common complication of hemorrhoidal disease. This condition causes extreme pain, likely resulting from internal anal sphincter hypertonicity, which traps the hemorrhoids below the dentate line thus leading to congestion and swelling. The choice of treatment remains controversial and both conservative and surgical options have been proposed in the last decades. This mini-review focuses on the most relevant studies found in literature evaluating conservative and surgical management of EHT. Special conditions such as pregnancy and EHT in elderly patients have been considered. Traditionally, symptoms duration represents the discriminant in the choice between medical and surgical treatment. Several Coloproctological Societies considered conservative treatment as the first-line approach to EHT and a variety of options have been proposed: wait and see, mixture of flavonoids, mix of lidocaine and nifedipine, botulinum toxin injection and topical application of 0.2% glyceryl trinitrate. Meanwhile, different surgical treatments are recommended when EHT fails to respond to conservative management or when symptoms onset falls within the last 48-72 h: drainage with radial incision, conventional excision, excision under local anesthesia and stapled technique. The management and treatment of EHT is still controversial since no specific guidelines have been published. Both medical and surgical treatment have been proven effective but randomized clinical trials and structured consensus-based guidelines are warranted.
Sections du résumé
Background
UNASSIGNED
External hemorrhoidal thrombosis (EHT) is a common complication of hemorrhoidal disease. This condition causes extreme pain, likely resulting from internal anal sphincter hypertonicity, which traps the hemorrhoids below the dentate line thus leading to congestion and swelling. The choice of treatment remains controversial and both conservative and surgical options have been proposed in the last decades.
Methods
UNASSIGNED
This mini-review focuses on the most relevant studies found in literature evaluating conservative and surgical management of EHT. Special conditions such as pregnancy and EHT in elderly patients have been considered.
Results
UNASSIGNED
Traditionally, symptoms duration represents the discriminant in the choice between medical and surgical treatment. Several Coloproctological Societies considered conservative treatment as the first-line approach to EHT and a variety of options have been proposed: wait and see, mixture of flavonoids, mix of lidocaine and nifedipine, botulinum toxin injection and topical application of 0.2% glyceryl trinitrate. Meanwhile, different surgical treatments are recommended when EHT fails to respond to conservative management or when symptoms onset falls within the last 48-72 h: drainage with radial incision, conventional excision, excision under local anesthesia and stapled technique.
Conclusion
UNASSIGNED
The management and treatment of EHT is still controversial since no specific guidelines have been published. Both medical and surgical treatment have been proven effective but randomized clinical trials and structured consensus-based guidelines are warranted.
Identifiants
pubmed: 35592120
doi: 10.3389/fsurg.2022.898850
pmc: PMC9110961
doi:
Types de publication
Journal Article
Review
Langues
eng
Pagination
898850Informations de copyright
Copyright © 2022 Picciariello, Rinaldi, Grossi, Verre, De Fazio, Dezi, Tomasicchio, Altomare and Gallo.
Déclaration de conflit d'intérêts
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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