Management of hemorrhoids in unusual circumstances

Hemorrhoids are a common problem managed by the general surgeon and colon and rectal surgeon alike. Most patients are managed conservatively or with office-based procedures. A minority of patients will require operative intervention. There are certain populations of patients in whom the approach to management must be carefully considered and tailored. The management of hemorrhoids in patients with HIV/AIDs, portal hypertension, acute thrombosis, inflammatory bowel disease, or who are pregnant or anticoagulated will be discussed. Occasionally hemorrhoidectomy specimens harbor histologic surprises and this will be discussed briefly.