A 47-year-old woman with long-standing symptomatic haemorrhoids presents with prolapsing piles that are permanently outside the anal verge and cannot be reduced manually; they are congested and tender. Examination excludes any anal canal lesion. What is the definitive treatment of choice?

• A Rubber band ligation
• B Injection sclerotherapy
• C Stapled haemorrhoidopexy alone as the only option
• D Excisional haemorrhoidectomy (Milligan-Morgan) ✓

Explanation

Grade IV haemorrhoids, which are irreducible and often strangulated, require excisional haemorrhoidectomy, the gold standard with the lowest recurrence. Rubber band ligation and sclerotherapy are office procedures suited to grade I to III disease and cannot address strangulated grade IV piles. Stapled haemorrhoidopexy is an alternative for circumferential grade III to IV disease but excision remains the standard answer for a single strangulated grade IV pile.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.