Female: 42 years old. Post-poo mass prolapsed for 8 years with acute impaction for 3 days. Localized with thrombosis. Urgent external and internal ligation of mixed hemorrhoids was performed. Preoperative photo. Giant prolapsed mixed hemorrhoid with cantonment. The diseased hemorrhoid nucleus was removed after surgery, preserving the normal skin and mucosal bridge. Photo taken at the follow-up 1 week after surgery. Good recovery.