Acute anal venous thrombosis I84.3

• Predisposing for the development of analthromboses is possibly the presence of enlarged hemorrhoidal cushions, which are connected to the caudal, subcutaneous venous plexus, so that with a possible flow slowdown in dilated vessels and a vascular wall injury the essential basics of the Virchow Triad are given.
• Triggering factors include thermal exposures, such as cold (e.g. sitting on cold surfaces) and muggy weather, (unusual) physical exertion, such as jogging, cycling or similar, increased intra-abdominal pressure during coughing, lifting, pressing, defecation, in the final stages of pregnancy and during the birth process, as well as female hormones (menstruation). Furthermore, nutritive influences (e.g. alcohol, spices) can be triggers for an anal thrombosis as well as mechanical factors (proctological interventions, anal intercourse).

• Blue-red or black, to cherry-sized knot protruding from the anal ring. No preference for certain sectors. Acutely occurring (within minutes to hours), sometimes very painful swelling at the anal rim or anus, accompanied by a dull, persistent pain, accompanied by itching, stinging, burning or a strong feeling of tension or pressure.
• During inspection and digital examination, there are bulging to rough, bluish-red knots ranging from pinhead to plum size on the anal rim or in the anal canal. Usually only one lesion is visible; rarely multiple small thromboses are arranged like pearls next to, behind or below each other.
• The fresh thrombosis does not bleed (no spontaneous relief). Under certain circumstances, however, pressure necrosis can lead to ulceration of the skin covering the thrombosis with consecutive bleeding and possibly spontaneous loss of the coagulation thrombus; this can lead to sudden relief of symptoms (spontaneous relief).

Therapy of the hemorrhoidal disease.

Untreated or under conservative therapy, the anal venous thrombosis recedes spontaneously over the course of days to weeks through organization, resorption and recanalization, without formation of a marisk. The duration of the disease is usually about one to two weeks. Rarely months may pass until complete regression.

• Camomile Seated baths, e.g. with camillosan. Apply cooling compresses (cool pack) or briefly ice water bags.
• Conservative therapy with anaesthetic ointments/suppositories such as cinchocaine (DoloPosterine) or anticoagulant topicals with heparin (e.g. Hepathromb Creme 60000).
• Application of haemorrhoid preparations containing glucocorticoids such as ointment compresses with betamethasone valerate (Betnesol V), 2-4 times/day. Alternatively, use preparations containing E. coli components (Posterisan suppositories with mullein insert (Haemotamp).

• Stab incision as early as possible and emptying of the blood coagula, if necessary with the application of a drainage, until the 4th day under local anaesthesia. From the 5th day (start of thrombus organization) surgical ablation in toto (excision of the entire thrombus area, taking the affected vascular segment with it) and antiphlogistic measures. The excision minimizes the risk of postoperative rethrombolization. In surgical procedures, removal of the sack-like dilated vein with a scalpel, thus preventing immediate sticking of the vein walls and recurrence. Hematoma drainage leads to immediate relief of pain.
• Follow-up treatment: Sitting baths with camillosan, insertion of an ointment strip with antiseptic additives such as polyvidon iodine (e.g. R204, Braunovidon ointment).