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Abstract: The patient usually has the habit of dry stool, and 1 week ago he developed anal pain and felt a swelling in the perianal area, which did not work well with topical medication, and he felt severe anal pain and the swelling became larger, so he came to the hospital and was diagnosed as thrombosed external hemorrhoid after examination. After standard treatment, the anal swelling and pain disappeared, and the patient did not recur during the follow-up.
Basic information】Female, 32 years old
Disease Type】Thrombosed external hemorrhoid
Hospital】Hegang City People’s Hospital
Date of Consultation】May, 2020
Treatment plan] Thrombosed external hemorrhoid removal + medication (cefdinir capsule anti-inflammatory, injectable hemagglutinin to stop bleeding, aminophenol oxycodone tablet to relieve pain) + anal incision disinfection and medication change
Treatment period】4 days of inpatient treatment, 2 weeks of outpatient medication change
Treatment effect】Anal swelling and pain disappeared
I. Initial consultation
The patient usually has the habit of having dry stools, and 1 week ago she developed anal pain and felt a swelling around her anus. Today, he felt serious anal pain and the anal lump became bigger, making walking and sitting inconvenient, so he came to the clinic for further treatment. The patient was found to have a purple-black swelling in the middle of the left side of the anus, such as the size of an egg yolk, which was painful to palpation, and the swelling was not palpable in the anus, and the finger sleeve was not stained with abnormal discharge.
II. Treatment history
The patient had been treated with topical hemorrhoid cream, but the effect was not good, and surgical treatment was recommended. After admission, routine blood, coagulation, biochemical and electrocardiogram examinations did not show any significant abnormality, and the patient did not have any medical disease. After clean enema, the patient was given a thrombosed external hemorrhoid removal under perianal local infiltration anesthesia, and the procedure was smooth. After the operation, the patient was given anti-inflammatory (oral cefdinir capsule), hemostatic (intramuscular injection of injectable hemagglutinin), analgesic (oral aminophenoxycodone tablet) and daily antiseptic dressing change for the anal incision.
III. Treatment effect
The patient’s thrombosed external hemorrhoid was discharged from the hospital after 4 days of surgical treatment with normal bowel discharge. The anal incision was completely healed after 2 weeks of outpatient medication change, and he was living and working normally. After the surgery, we insisted on changing the medication and diet, no incision infection occurred, and no complications such as anal edema and bleeding were seen until the anal incision was completely healed, the bowel discharge was smooth, and there was no pain in the anus, and no recurrence of external hemorrhoid was seen during the follow-up.
IV. Notes
We are glad that the anal swelling and pain disappeared after treatment. Patients do not need to fast after surgery, but in the early stage, easy-to-digest food is still the main focus, and as the condition recovers, it can be gradually transitioned to a normal diet. For raw, cold, greasy and spicy food should be prohibited, even after the patient recovers, it should be eaten sparingly or not. Patients can get out of bed on the day after surgery, but only for a slow walk, not for strenuous exercise to avoid bleeding from the anal incision tear, and gradually return to normal activities with the healing of the incision. Patients should drink more water and eat more green vegetables and fruits in order to facilitate the smooth flow of stool, and have regular bowel movements without exerting too much force for more than 5 minutes.
V. Personal insight
In this case, the patient’s thrombosed external hemorrhoid had an acute onset and did not improve with self medication, so he came to the hospital in time and recovered in a relatively short period of time after surgery, which illustrates the necessity of early diagnosis and treatment. The patient was very cooperative with the doctor in treating the disease and insisted on outpatient follow-up medication changes after discharge, and the final result was satisfactory. The onset of thrombosed external hemorrhoids is closely related to constipation, and combined with the patient’s history of dry stools in this case, it is recommended that patients with constipation habits should be treated actively.