From a digital rectal exam to hemorrhoidal necrosis

Abstract text (incl. references and figure legends)

Case History: A 38 years old male patient entered the emergency room with complaints of pain in the anal region. The pain started after a great effort to defecate, referring that he had been feeling a mass in the perianal area for a month. Clinical Findings: Using left lateral decubitus position: edematous external hemorrhoids, with external hemorrhoidal pedicle at 9 o'clock, with advanced signs of poor arterial perfusion. On the digital rectal exam we found, the sphincter was normotonic, with feces in the rectal ampulla and the gloved finger was bloodless. The pedicle was reduced to the anal cavity. Investigation/Results: Analytically with WBC 11000/L, CRP 0.12 mg/dL, PCT 0.03 ng / mL, Hb 15.4 g/dL, serum creatinine 1.06 mg/dL. Diagnosis: Hemorrhoidal Necrosis. Therapy and Progression: Underwent excision of a necrotic hemorrhoidal pedicle, with no evidence of necrosis extension beyond the excised pedicle. Anatomopathological result: anorectal transition hemorrhoid with ischemic changes. Comments: Acutely thrombosed or strangulated hemorrhoids typically manifest with intense discomfort and irreducible hemorrhoids. The entrapped hemorrhoids may necrotize and drain. Surgical excision of the affected pile is advised in cases of significant discomfort, necrosis, or infection. Bibliography: Lohsiriwat V. Treatment of hemorrhoids: A coloproctologist's view.;De Schepper H, et al. Belgian consensus guideline on the management of hemorrhoidal disease.

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