ROSH Gastrointestinal Practice Exam

In the acute setting, what represents appropriate management for a thrombosed external hemorrhoid?

1. Excision

2. Reduction

3. Sitz baths

4. Surgery referral

The correct answer is: Reduction

In the acute setting, the management of a thrombosed external hemorrhoid typically involves the process of reduction. This is because, during this stage, the focus is on alleviating the acute pain and discomfort associated with the thrombosis. Reduction may involve manual manipulation to relieve pressure or occasionally the use of topical medications to manage symptoms, offering immediate relief. It's important to recognize that while excision may be appropriate for longstanding or chronic external hemorrhoids, it is not usually necessary in the acute phase, especially if immediate surgical intervention is not warranted. Sitz baths are often recommended for symptomatic relief as part of overall hemorrhoid care, but they do not actively treat the thrombosis itself. Surgical referral, while potentially necessary in complicated cases or when there are other underlying issues, is not the first-line approach for a straightforward thrombosed external hemorrhoid when effective management can be achieved through reduction methods.