Hemorrhoids are vascular structures essential for maintaining anal continence. Their dysfunction can lead to symptomatic hemorrhoidal disease, a common condition in adults. Hemorrhoidal thrombosis is an acute complication that requires specific management, which differs depending on whether the thrombosis is external or internal. We report the case of a 43-year-old man, a former smoker, presenting with a thrombosed grade IV internal hemorrhoidal prolapse, diagnosed clinically based on acute anal pain and inflammatory edema. Initial conservative management, including analgesics, corticosteroids, venotonics, and laxatives, led to a gradual improvement in symptoms. This was followed by a Milligan-Morgan hemorrhoidectomy performed after resolution of the inflammatory phase, resulting in complete healing within three months. This case highlights the relevance of a stepwise therapeutic strategy in the management of internal hemorrhoidal thrombosis, starting with medical treatment to control symptoms and optimally prepare for delayed surgery if necessary, in accordance with current guidelines.
Yannick et al. (2025) studied this question.