Relief of a Painful Peri-anal Haematoma
A typically painful peri-anal haematoma is depicted
in Figure 1.
It is covered by tense anoderm ie:
Skin devoid of hair and sebaceous glands. Often the blood clot
within the haematoma can be seen deep to the thin covering. At
other times oedema obscures the discolouration.
figure 1. Tense swelling at the anus devoid
of hair.
TECHNIQUE
This is shown in the diagrams and described in the
legends of Figures 2A-2E. Very large haematomas are best treated
in a
day centre by excision. Haematomas which are no longer painful
are best left untreated. After the emergency treatment investigations
such as colonoscopy are required.
AFTER CARE
This is minimal. Mild analgesics
are given. A pad and Sitz baths are useful.
COMPLICATIONS
These are uncommon. They occur if the original
incision is inadequate and the haematoma refills the wound.
This complication
can be
avoided by complete removal of the external haemorrhoid,
usually performed in a Day Centre.
figure 2a. Infiltration of the peri-anal haematoma
and surrounding tissues with 2-5 ccs of Xylocaine 1% with adrenaline
1: 100,000.
figure 2b. An incision is made over the length
of the haematoma. It does not matter in which direction the incision
is made.
figure 2c. A clot is expelled using gloved fingers.
figure 2d. It is advantageous to remove small
secondary blood clots. Use a fine pair of scissors and toothed
forceps
to hold your incision open.
figure 2e. To prevent a recurrent problem a
large haematoma can be opened by an excision of a small area
of covering.
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