Thrombosis of gemorroidalny knot – the complication of a course of hemorrhoids which is characterized by formation of blood clot in kavernozny vascular textures of a rectum. The main signs – the expressed pain and feeling of a foreign matter in anal area. For diagnosis of thrombosis of gemorroidalny knots inspection of rectal area, a rektoskopiya, the general blood test, a koagulogramma is performed. Medical tactics is defined by weight of a state. Conservative therapy provides purpose of local and system anti-inflammatory medicines, local trombolitik, venotoniziruyushchy means and anesthetics. Surgical treatment consists in performance of a trombektomiya or gemorroidektomiya.
Thrombosis of gemorroidalny knot
Thrombosis of gemorroidalny knot - the violation of blood circulation in kavernozny textures of a rectum which is followed by formation of a blood clot - blood clot. The sharp state lasts about five days then the trombirovanny inflamed knot is exposed to replacement with connecting fabric; the nekrotizirovaniye and an ulceration mucous is possible. Sharp gemorroidalny thrombosis is diagnosed approximately for 27% of all patients with the verified diagnosis of hemorrhoids, and its share among all complications makes 60%. In the conditions of lack of adequate treatment development of heavy complications which not only significantly worsen a condition of the patient is possible, but also can lead to a lethal outcome. Relevance of a problem consists in temporary effect of conservative methods of treatment, high frequency of a recurrence and the unsatisfactory remote results after surgical intervention, and, therefore – absence in a proktologiya of the uniform concept of medical tactics.
Depending on what knots are struck, allocate the external, internal and combined gemorroidalny thrombosis. Also thrombosis of gemorroidalny knots is classified on three degrees depending on extensiveness of pathological process and expressiveness of a clinical picture.
Reasons of thrombosis of gemorroidalny knots
Sharp thrombosis of gemorroidalny knots develops under the influence of various factors worsening a condition varikozno of the changed veins of a rectal texture. In development of this complication violation of a diet plays a role: excessive alcohol intake, various seasonings, salt, bitter and spicy food. These food are dangerous that they stimulate blood circulation in a small basin and increase pressure in gemorroidalny knots. An important factor is change of work of a digestive tract in the form of locks or ponos which adversely influence blood circulation in gemorroidalny textures. Locks arise at insufficient consumption of products which contain a lot of vegetable cellulose: vegetables, fruit, bran and others.
The hypodynamia is considered the following reason of development of thrombosis of gemorroidalny knots, namely - long sitting therefore there are developments of stagnation in vessels of a small pelvis; it leads to formation of blood clots in kavernozny textures and to an exacerbation of a disease. Often thrombosis arises after the delivery. Thus, thrombosis of gemorroidalny knot practically always develops after its travmatization.
Quite often sharp thrombosis of internal gemorroidalny knots is preceded by the spasm of an anal sphincter arising owing to the above-mentioned reasons as the answer to painful irritation. As a result of a spasm in the dropped-out knots blood circulation significantly is broken, there is a stagnation of blood and a tromboobrazovaniye, hypostasis and an intensive pain syndrome develops, and usually all dropped-out knots are surprised. This state develops sharply, at the same time the natuzhivaniye most often is decisive factor. At external gemorroidalny thrombosis the tromboobrazovaniye, as a rule, occurs in one of knots therefore a clinical picture less bright.
Symptoms of thrombosis of gemorroidalny knot
The leading symptoms of thrombosis of gemorroidalny knot are intensive crotch pains, and also discomfort in back pass. Pain is constant, it is not connected with the act of defecation. Density of knot and its sizes increase, and patients can note feeling of a foreign matter in a rectum. As at this pathological state accession of an inflammation is possible, such symptoms as a hyperthermia, the general weakness, nausea are characteristic.
Clinical displays of thrombosis of gemorroidalny knots depend on its degree. At the first degree thrombosis is not followed by an inflammation. In this case increase in gemorroidalny knots with increase in their density is observed. The touch to knots causes their insignificant morbidity. The patient is disturbed by the unpleasant feelings in the field of back pass amplifying at defecation. At survey insignificant hypostasis and hyperaemia in the field of an anus is observed.
At the second severity inflammatory process in knots joins thrombosis. At this stage puffiness and the expressed hyperaemia in perianalny area is noted. At a palpation gemorroidalny knots are very painful.
The third stage of process, besides a tromboobrazovaniye and an inflammation in gemorroidalny knots, is followed by development of inflammatory infiltration in hypodermic cellulose of perianalny area. In certain cases pathological process extends to all pararectal cellulose. The manual research of a rectum and a palpation of gemorroidalny knots cause intolerable pain. Visual survey allows to reveal the crimson and cyanotic knots which are dropping out of a rectum. From thrombosis complications intensive bleedings, widespread hypostasis in a rectal zone most often meet, purulent paraproktit also a necrosis of gemorroidalny knots.
Diagnosis of thrombosis of gemorroidalny knot
As a rule, for verification of thrombosis of gemorroidalny knot of rather typical clinical picture. The important part in diagnostics is assigned to collecting complaints, the anamnesis, and also survey of perianalny area. Survey at the first severity allows to reveal existence of the trombirovanny gemorroidalny knots condensed and increased in sizes, moderately painful at a palpation. At external gemorroidalny thrombosis one knot is usually struck, at internal - loss of gemorroidalny knots is defined.
During the progressing of pathological process and accession of signs of an inflammation it is possible to find the expressed stagnant hyperaemia of knots. The third severity is characterized by existence at survey of continuous inflammatory infiltrate in a perianalny zone. Besides, can the necrosis of separate gemorroidalny knots which have cyanotic-crimson or black color is noted.
Trombirovanny external gemorroidalny knots are visualized below the grebeshkovy line, at internal thrombosis there is a groove between the dropped-out knot and edematous skin of a perianalny zone. Thrombosis of internal gemorroidalny knots in the absence of loss is defined at a manual rectal research: the dense sharply painful roundish educations which are not falling down when pressing are palpated.
From laboratory methods of a research the koagulogramma is informative: in it signs of violation of system of a hemostasis come to light. In the general blood test at accession of an inflammation increase in quantity of leukocytes at the expense of stab forms is defined. For specification of the diagnosis, especially at suspicion of internal thrombosis, and exceptions of other diseases which are followed by an intensive pain syndrome (cancer of a rectum, the restrained dropped-out polyp of a rectum, a sharp paraproktit) the rektoskopiya is carried out.
Treatment of thrombosis of gemorroidalny knot
For treatment of thrombosis of gemorroidalny knot proctologists use complex therapy which is defined differentially depending on extent of violation of microcirculation. At the first and second severity multicomponent conservative therapy is proved. Thrombolytic means in the form of gels, ointments or candles are appointed. These are medicines on the basis of heparin which have high efficiency in elimination of thromboses and in prevention of formation of blood clots further. Also anesthetics which allow to stop intensive pain are used and to improve a condition of patients. In the presence of signs of an inflammation nonsteroid medicines and glucocorticoids are appointed.
Anti-inflammatory treatment is appointed locally in the form of ointments, and also orally or parenterally. At active inflammatory process the combination of local treatment with intramuscular or intravenous administration of resolvents is possible. Also medicines with venotoniziruyushchy effect are applied. As additional conservative treatment cold compresses on area of a crotch which allow to eliminate pain are shown to patients and to reduce expressiveness of an inflammation.
The third degree of thrombosis of gemorroidalny knots is the indication to surgical treatment. Operation can be performed in urgent (within the first two days) or the delayed order (in 4-5 days) that is defined by existence or lack of infringement of knots, need of knocking over of an acute inflammation. The most widespread operation is the trombektomiya. This intervention, rather small on volume, which provides opening of knot and removal from it of blood clot then surgeons do not take in a postoperative wound, giving it the chance to heal independently. On final healing no more than 2-3 days leave. Such tactics is applied at external thrombosis of one or two knots. At more extensive defeat the gemorroidektomiya with restoration of integrity of a mucous membrane of the anal channel is carried out. This intervention allows to achieve the optimum remote results.
In certain cases at extensive thrombosis with the expressed perianalny hypostasis and a sharp pain syndrome the back dosed sfinkterotomiya is applied. In the presence of complications, such as an inflammation of pararectal cellulose or a necrosis of gemorroidalny knot, carry out more radical surgeries. Operations at a paraproktita provide drainage of perianalny cellulose for reduction of inflammatory infiltration.
Forecast and prevention of thrombosis of gemorroidalny knot
At correctly appointed treatment the forecast at thrombosis of gemorroidalny knot favorable. Against the background of lack of adequate therapy complications in the form of a paraproktit, a necrosis of gemorroidalny knot are possible that significantly worsens the forecast. For prevention of thrombosis patients with the available chronic hemorrhoids need to follow certain recommendations for preventing of traumatizing gemorroidalny knots and a tromboobrazovaniye. In particular, it is necessary to control work of intestines, trying to obtain normalization of a chair, avoiding locks and ponos. For this purpose it is necessary to keep to the recommended diet with an exception of too spicy and put too much salt food, and also spices and alcohol. At a daily diet there have to be enough vegetables and the fruit containing cellulose, fermented milk products, grain. It is recommended to normalize physical activity.