ACSTRAUMAVAULTACUTE CARE SURGERY← ACS Vault
ANORECTAL EMERGENCIES • SENIOR RESIDENT / SURGEON

Acute Anorectal Emergencies

Acute anorectal pain most commonly narrows quickly to fissure, abscess or thrombosed external hemorrhoid, but the exam determines which.

PROTOTYPE REVIEW REQUIRED
01
The Call

37-year-old man

Four days of anorectal pain and pressure with new drainage. Exam shows erythema, induration and fluctuance adjacent to the anus.

Stable
Fluctuance and drainage point toward abscess, not uncomplicated hemorrhoidal disease.
Read the Image • Clinical DataACS VISUAL
Thrombosed external hemorrhoid from the ACS image archive.
Thrombosed external hemorrhoid from the ACS image archive.
Make the Decision • Commit to a Plan

A patient presents within 48 hours of onset of a very painful thrombosed external hemorrhoid that limits function. Best management option?