Perianal Haematoma

DEFINITION
AKA 'thrombosed external haemorrhoid'.
Contained haemorrhage within an
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EPIDEMIOLOGY

Common

Risk factors
Occupations with straining
Constipation
Pregnancy
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AETIOLOGY

See below
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BIOLOGICAL BEHAVIOUR

Pathophysiology

E.g. straining with constipation or work
Rupture / thrombosis of veins at external haemorrhoidal plexus.
- may occur during vigorous activity.
After a few days the haematoma undergoes fibrosis.
A skin tag remains at the site.

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MANIFESTATIONS

Acute pain with thrombosis.
Generally reduces after 48-72h.
Thrombosis visible as a grape-like swelling
- if its not obvious, something else is probably causing the pain.
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INVESTIGATIONS

N/A
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MANAGEMENT

Resection is now rarely indicated.
Pain subsides within a few days
Stabilize with Sitz baths and mild analgesics.
RCT evidence that topical 0.3% nifedipine cream reduces pain

Incision
Can be performed if pain intolerable.
Local anaesthesia.
Leave skin edges to heal by secondary intention.

Excision

Preferred to incision.
Reduces recurrent
And often enucleation is not straightforward.
UNLESS performed within 24h, evidence shows:
- cumulative pain of excision and perianal is worse than just perianal.
- so don't do it unless early.

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REFERENCES
Cameron 10th