Treatment of acute hemorrhoidal crisis using hyaluronidase with local anesthetic prior to surgical excision

Excerpt

Acute hemorrhoidal crisis is rare and characterized by unrelenting pain of abrupt onset that usually requires emergent surgical treatment [1]. Classically, all three hemorrhoidal complexes are prolapsed and edematous leading to incarceration. Strangulation, necrosis, and gangrene can develop. According to the practice parameters for the management of hemorrhoids of the American Society of Colon and Rectal Surgeons [2], patients with thrombosed external hemorrhoids benefit from surgical excision within 72 h of symptom onset. When compared to elective hemorrhoidectomy, emergent hemorrhoidectomy is associated with more early complications (i.e., urinary retention, bleeding, fecal impaction, and abscess), higher rates of reoperation, and anal stenosis [3]. …