Hemorrhoids
159 results
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Hemorrhoids- Key Concepts
- Epidemiology
- Anatomy
- Pathogenesis
- Clinical Presentation
- History
- Treatment
- Medical Management
- Office-Based Procedures
- Thrombosed Hemorrhoid Excision
- Operative Management of Hemorrhoids
- Excisional Hemorrhoidectomy Closed Technique (Ferguson Technique)
- Excisional Hemorrhoidectomy Open Technique (Milligan-Morgan)
- Use of Energy Devices in Excisional Hemorrhoidectomy
- Whitehead Hemorrhoidectomy
- Stapled Hemorrhoidopexy
- Doppler-Guided Hemorrhoidectomy
- Pain Management and Postoperative Care
- Complications of Hemorrhoidectomy
- Special Patient Populations
- Conclusion
- References
Management of Hemorrhoids (2024)
Hemorrhoids: The Good, Bad, and Ugly- Mastering Management of Hemorrhoids: Operative and Non-Operative Strategies as well as Post-Operative Troubleshooting
Anorectal Disease- A 72-year-old man currently on apixaban after recent coronary artery stent placement presents to your office with intermittent rectal bleeding with defecation. He has increased his dietary fiber and water intake. Anoscopy shows grade 2 internal hemorrhoids. What is the best next step in the management of this patient?
- A 40-year-old man presents to your office and reports pain and swelling with the inability to defecate for the last few days. Symptoms started after an episode of constipation where he strained on the toilet for quite some time. On examination, the patient has exquisite tenderness in the perianal area along with other findings, as shown in the image. What is the most appropriate treatment?
- A 28-year-old woman presents in her 36th week of pregnancy with 3 days duration of severe anorectal pain. The pregnancy has been otherwise unremarkable. Vital signs are normal. On examination, circumferential prolapsing, strangulated thrombosed hemorrhoids are seen. The best next step in management is
- A 72-year-old with primary sclerosing cholangitis (PSC) is admitted with lower gastrointestinal bleeding that has persisted for 72 hours. Physical examination reveals caput medusa as well as enlarged external hemorrhoids. A diagnostic colonoscopy reveals multiple bleeding submucosal vessels near the anorectal junction. The most appropriate management is
- A 40-year-old undergoes an emergency excisional hemorrhoidectomy for strangulated, prolapsing grade 4 internal hemorrhoids (Figure 1). Eight weeks following surgery, the patient report narrow caliber stools, tenesmus, and constipation (Figure 2). What operative technique could prevent the findings in Figure 2?
- A 34-year-old patient presents with a 2-day history of severe rectal pain, which is constant and not related to bowel movements. On examinaton, the patient has no external hemorrhoids or lesions and you cannot perform a digital rectal examination (DRE) due to extreme pain. What is the most likely diagnosis?
- A healthy 45-year-old male patient presents with constipation and hemorrhoids. Patient reports that after a bowel movement, hemorrhoidal swelling subsides on its own. On perianal examination, there are no external hemorrhoids. Anoscopic exam reveals a large right anterior internal hemorrhoid. What is the first step in management?
- Physical examination of a 45-year-old male patient who has chronic constipation demonstrated enlarged circumferential external hemorrhoids. On vasalva, internal hemorrhoids prolapsed out of the anal canal and had to be manually reduced. The grade of internal hemorrhoids with these clinical findings is
- A 38-year-old patient presents with symptomatic grade 3 internal hemorrhoids. Which of the following is a contraindication to stapled hemorrhoidopexy?
- A 46-year-old man presents to your office with rectal bleeding associated with bowel movements and prolapse of tissue from his anus that spontaneously reduces. Recent colonoscopy demonstrated moderate internal hemorrhoids and a 3-mm tubular adenoma in the sigmoid colon removed with cold forceps. A single rubber band ligation was performed during this procedure. Two days later, he presents to the emergency department with a fever of 102°C, pelvic pain, and urinary retention. The most definitive treatment is
- Patient presents with bleeding per rectum with bowel movements and partial hemorrhoidal prolapse with straining and spontaneous reduction. Patient had a colonoscopy 12 months ago that only showed enlarged hemorrhoids. Patient has been on supplemental fiber for the past 6 months. The best next treatment for this patient’s rectal bleeding is
- A 37-year-old man presented to you with intermittent hemorrhoid bleeding and irritation. He reported a long history of constipation and straining with bowel movements. He has embraced a high fiber diet and increased water intake. Bowel movements are passing well without straining. He still notes large anal tags and intermittent irritation though much less bleeding. His symptoms have not completely resolved. He is interested in additional treatment to reduce symptoms. The best option for him at this time is
- A 65-year-old patient undergoes rubber band ligation of two hemorrhoid columns on the same day in the office. Three days later the patient calls to report extreme anal pain, fevers, and urinary retention. Which of the following is the best next step for this patient?
Anorectal Disease- A 47-year-old man with chronic constipation presents with increasingly painful prolapsed perianal tissue of 3 days’ duration (Figure) Which of the following is the best next step in treatment?
- A 68-year-old man with end-stage liver disease presents with repeated episodes of lower gastrointestinal bleeding resulting in symptomatic anemia with hypotension. Colonoscopy shows prominent veins in the submucosa of the lower rectum. Which of the following is the most durable treatment option?
- An 80-year-old woman presents with anal pruritus and prolapsing internal hemorrhoids. She has fecal urgency and occasional fecal accidents. On anoscopy, grade 2 internal hemorrhoids are visualized. What is the best option for treating her internal hemorrhoids?
- A 37-year-old homosexual man presents for evaluation for anal bleeding and prolapsing internal hemorrhoids. He reports only transient improvement after several rubber band ligations. On examination, grade III internal hemorrhoids are noted with a minimal external hemorrhoidal component. What is the next step in management?
- A 35-year-old man presents to the office for evaluation for anal itching and an episode of painless rectal bleeding. On examination, he has small hemorrhoidal skin tags. Office anoscopy shows grade I internal hemorrhoids. What is the initial treatment of choice?
- A 67-year-old patient presents with a 2-year history of recurrent hemorrhoid swelling, difficulty cleaning, and bright red blood with bowel movements despite fiber supplementation and avoidance of straining. Examination reveals grade III hemorrhoids with a large external component. Which of the following would be the most effective treatment?
- A patient presents with difficult and painful evacuation 2 months after undergoing Ferguson excisional hemorrhoidectomy for acutely thrombosed grade IV internal and external hemorrhoids. An examination reveals anal stenosis. What is the most likely cause of the anal stenosis?
- A healthy 41-year-old man presents to your office complaining of blood on the toilet paper after each bowel movement for the past 6 months. On anoscopy, grade II internal hemorrhoids with stigmata of bleeding are found. Which of the following is the most appropriate management?
- A 72-year-old man with obesity underwent an uneventful outpatient 2-quadrant rubber band ligation for bleeding hemorrhoids 4 days ago. He now reports vague perianal pain. Which additional symptom raises the suspicion for procedure-related sepsis?
- A 55-year-old man presents with malaise, fatigue, inability to urinate, temperature of 102°F (38.8°C) and a heart rate of 115 beats/min 4 days after undergoing rubber band ligation for bleeding internal hemorrhoids. What is the next step in management?
- A 78-year-old man with atrial fibrillation seeks inpatient consultation for persistent bright red blood per rectum. He is hemodynamically stable. After holding anticoagulation, colonoscopy demonstrates internal hemorrhoids with stigmata of bleeding. What is the most appropriate next step in management?
- Pelvic Floor
- A 37-year-old woman with a body mass index of 18 kg/m2 has been experiencing rectal pain for 6 months. She has no rectal bleeding, no family history of colon disease, and no chronic change in bowel habits. Findings of digital rectal examination, anoscopy, and flexible sigmoidoscopy are remarkable for grade 2 internal hemorrhoids and tenderness with manipulation of the coccyx. What is the best next step in management?
- An 80-year-old woman with multiple comorbidities has hemorrhoids and fecal incontinence. On examination, you observe full-thickness rectal prolapse and offer a perineal proctectomy. What additional procedure may improve continence?
- Benign Disease
- Anatomy and Embryology of the Colon, Rectum, and Anus
- Malignancy
- Anorectal Crohn’s Disease
- question 25
- Malignancy