Clinical current features and treatment tactics of acute external hemorrhoids in outpatient and polyclinic conditions

Abstract

Purpose of the study. The study of the current problems for acute external hemorrhoids (AEH) diagnosis and treatment from the point of view of a practicing ambulatory coloproctologist in the Tver region (based on an analysis of the clinical features of the disease, its course and the applied tactics of the coloproctologist) was made.Patients and methods. A retrospective study with continuous series of 124 patients (2016–2017), using clinical and statistical research methods.Results. Acute external hemorrhoids (AEH) is a painful formation that suddenly arises due to acute thrombosis of the external hemorrhoid plexus, located near the anus, mainly at 3, 5, 7 hours on the proctological dial, with a free space between the hemorrhoid and the mucous membrane of the anal canal. Patients with AEH turned to the ambulatory coloproctologist at a later date (on average 11.7 days after the onset of the disease), most often without pain or with slight pain in the anus, with mild and moderate severity of the disease. The main complications of AEH were necrosis and hemorrhoidal wall rupture with bleeding from it. Conservative treatment of patients with AEH was due to clinical guidelines of the Russian Coloproctologists Association (RCA); it was ineffective in 11.3% of patients, who underwent outpatient surgery. All patients with severe pain, high grades of AEH, were offered for hospitalization to the surgical department (including coloproctologcal), but they refused. Low operative activity and late surgery in patients with AEH, who applied to the polyclinic, were due to the fact that only 12 (9.7%) patients sought help within the first 72 hours of the onset of the disease, low severity of pain, as well as the patients refused the proposed operations.Conclusions. The studied features of the outpatient coloproctologic service in AEH reveal the inadequate availability of system resources for patients, inappropriate informing the population with «mass-media» technologies; it makes difficulties to implement the recommendations of the RCA.