Compression and tamponade of the anal canal in case of acute
distal hemorrhage as bridging for stabilization until definitive
assessment or procedure is possible (Figure 5–1).
Balloon tamponade of the anal canal.
Where needed, when no immediate access to OR.
Examination and surgical hemostasis in OR.
Massive hemorrhage (postsurgical, spontaneous hemorrhoidal, or
- 1. Patient positioning:
- 2. Insertion of largest available
Foley catheter into anal canal.
- 3. Insufflation of balloon with
60 mL of water/saline.
- 4. External traction on catheter
to allow balloon to exert pressure on anal canal.
- 5. Placement of external pad
pack (gauze, towels) around catheter (external counter pressure).
- 6. Placement of hemostat clamp
to catheter (under tension) at level of external packing.
Hemodynamic stabilization, monitoring.
Antibiotic coverage as long as balloon in place.
Maximal length of tamponade: 24 hours.
Plan for definitive surgical care.
Continued bleeding, anal canal necrosis, infection.
Decompression of perirectal abscess to allow resolution of acute
inflammation and pressure (pain!). Management of fistula only of
secondary priority: if I&D is performed under general anesthesia,
excision of the cryptoglandular origin and definitive fistula procedure
may be reasonable, but there is increased risk of creating tracts
that are not truly there (inflamed tissue).
Outpatient, office (or inpatient, bedside/OR procedure
in selected cases).
Nonoperative management: generally not indicated except if abscess
Modified Hanley procedure for horseshoe abscess.
Every perirectal abscess.
Clinical assessment, ie, pain and local inflammatory signs; do
not wait for fluctuance in perirectal area. Neither WBC nor imaging
studies are needed (except in very unusual circumstances).
In all patients receiving general anesthesia: at least rigid