Thursday, 26 May 2011

Perianal haematoma

This is also called thrombosed external haemorrhoid and it relates anatomically to the veins of the external haemorrhoidal plexus. It is usually consequent upon straining at stool, coughing or lifting a heavy weight (back pressure on an anal venule).

The condition appears suddenly and is very painful. On examination an olive-shaped, blue (resembling a semi-ripe blackcurrant) tense, tender subcutaneous swelling at the anal margin is seen. The haematoma is usually situated in a lateral region of the anal margin. If it is left untreated it may give rise to a skin tag or burst and extrude the clot or bleed. Resolution or fibrosis usually occurs. The condition has been called ‘a 5-day, painful, self-curing lesion’ by Edward Milligan of England.

If the patient presents within the first 48 hours the haematoma may be evacuated under local anaesthesia and the wound is allowed to granulate. If the perianal haematoma is situated anteriorly or posteriorly, it should be treated conservatively because of the liability of the wound in these regions to become an anal fissure.

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Main Works of Reference List (The first eight are my top favourites)

  • British National Formulary
  • British National Formulary for Children
  • Guidelines (BAD - BASHH - BHIVA - Uroweb)
  • Oxford Handbook of Genitourinary Medicine, HIV, and Sexual Health
  • Oxford Handbook of Medical Dermatology
  • Rook's Textbook of Dermatology
  • Simple Skin Surgery
  • Weedon's Skin Pathology
  • A Concise Atlas of Dermatopathology (P Mckee)
  • Andrews' Diseases of the Skin
  • Andrology (Nieschlag E FRCP, Behre M and Nieschlag S)
  • Bailey and Love's Short Practice of Surgery
  • Davidson's Essentials of Medicine
  • Davidson's Principles and Practice of Medicine
  • Fitzpatrick's Colour Atlas and Synopsis of Clinical Dermatology (Klaus Wolff FRCP and Richard Allen Johnson)
  • Fitzpatrick’s Dermatology in General Medicine
  • Ganong's Review of Medical Physiology
  • Gray's Anatomy
  • Hamilton Bailey's Demonstrations of Physical Signs in Clinical Surgery
  • Hutchison's Clinical Methods
  • Lever's Histopathology of the Skin
  • Lever's Histopathology of the Skin (Atlas and Synopsis)
  • Macleod's Clinical Examination
  • Martindale: The Complete Drug Reference
  • Oxford Handbook of Clinical Examination and Practical Skills
  • Oxford Textbook of Medicine
  • Practical Dermatopathology (R Rapini)
  • Sexually Transmitted Diseases (Holmes K et al)
  • Statistics in Clinical Practice (D Coggon FRCP)
  • Stockley's Drug Interactions
  • Treatment of Skin Disease: Comprehensive Therapeutic Strategies
  • Yen & Jaffe's Reproductive Endocrinology