DOI: https://doi.org/10.36347/sjmcr.2025.v13i07.057

Pages: 1742-1745

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.