A 45-year-old man presents with a thrombosed external haemorrhoid of 48 hours duration. He is in severe pain. Examination reveals a single purplish, tense nodule at the anal verge. What is the most appropriate management?
- A Milligan-Morgan haemorrhoidectomy under spinal anaesthesia
- B Topical nifedipine and oral NSAIDs with review in 2 weeks
- C Incision and evacuation of the thrombus under local anaesthesia ✓
- D Rubber band ligation in the outpatient clinic
Correct answer: C. Incision and evacuation of the thrombus under local anaesthesia
Explanation
An acutely thrombosed external haemorrhoid presenting within 72 hours is best treated by incision and evacuation of the clot under local anaesthesia, which provides immediate pain relief. Haemorrhoidectomy is reserved for complex or recurrent cases. Rubber band ligation is for internal haemorrhoids. Conservative measures are for less severe cases.
Reference: Bailey and Love's Short Practice of Surgery, 28th ed.
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