Hemorrhoid external

External hemorrhoid

External piles form at or just outside the anal orifice.

They are invariably covered with skin, not mucosa,and this is endowed with ordinary cutaneous sensation they may be extremely painful.

2 Groups

1.Thrombosed external hemorrhoid or anal hematomas

Symptom and sign: sudden development of the painful lump at the anus, relates with constipation and straining of defecation

On examination: rounded swelling at the anal orifice, covered wirh tense stretched skin, bluish colour of the contained clot.

Subsequent course: completelt resolution 1-3 weeks,

but often:residual loose skin tag, sometime:rupture hemaotma, sometime:abscess of fistula formation

Treatment

- consservative treatment: hot bath, sedattive, pain control

- operative treatment: evacuation of the cclot: local anesthesia, short incision placed over the clot, squeezed out between finger and thumb

2.Chronic anal skin tag

Idiopathic skin tag; soft, pliable and covered by normal skin

Treatment: not require exceptionally large, patient may complain of discomfort.....and ask for its removal.

Simple operation: LA , taken to leave a flat peat-shaped or triangular open wound

Secondary skin tag: anal fissure(stiff with edema with fissure, after healing it becomes flaccid skin tag), pruritis ani(edema,infected skin rugue and anal&peranal skin change)

Differential diagnosis: anal earts, condyloma or carcinoma

Hypertrophied anal papillae

Symptoms: projecting mass at the anal orifice during defecation and requiring to be replaced digitally (patient: complaining that he has prolapsing piled). A fibrosed hypertrophied papilla is also frequently found at the upper end of a chronic anal fissure.

Diagnosis

Any size anal papillae can be easily palpated by examining finger either as minute nodules of thickening at the mucocutaneous junction.(Best by on proctoscopy)

Treatment

Ligation and excision of papilla: exposure by bivalve speculum, injection xylocaine into its base, crushing--> ligation and excision

Aute cryptitis and papillitis

Anal valve or papilla --> swollen, reddened, tender and sometimed adrop of pus

Operation: ;ay the track open