A 55-year-old woman with long-standing piles presents with severe pain and a palpable, dusky, edematous mass at the anal verge that cannot be reduced after manual attempts. She has no systemic illness. What is the definitive treatment of choice?
- A Rubber band ligation
- B Injection sclerotherapy
- C Excisional hemorrhoidectomy ✓
- D Anal dilatation
Correct answer: C. Excisional hemorrhoidectomy
Explanation
Grade IV hemorrhoids are irreducible and, when acutely prolapsed and incarcerated with strangulation, require excisional hemorrhoidectomy, which also removes any necrotic tissue. Rubber band ligation and injection sclerotherapy are office procedures for grade I to III disease and cannot address an incarcerated, strangulated prolapse. Manual reduction under anesthesia may be attempted first in selected patients, but definitive control needs excision.
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.