A 40-year-old male presents with bright red blood per rectum during defecation and a painful perianal lump that developed suddenly after straining. Examination reveals a tense, bluish, tender mass covered by anoderm at the anal verge. What is the diagnosis?

Answer and explanation

Correct answer: B. Thrombosed external hemorrhoid

  1. Step 1: An acute thrombosed external hemorrhoid is caused by intravascular thrombosis of the subcutaneous external hemorrhoidal venous plexus distal to the dentate line.
  2. Step 2: It presents as a sudden, exquisitely tender, purplish-blue subcutaneous nodule covered by sensitive perianal skin.
  3. Step 3: Surgical excision under local anesthesia provides rapid relief if performed within the first 48 to 72 hours.
Answer
Thrombosed external hemorrhoid.
Why not the others: 'Anal fistula' is a chronic granulomatous tract discharging pus and serous fluid; 'Internal hemorrhoid Grade IV' is permanently prolapsed mucosal tissue from above the dentate line that cannot be manually reduced; 'Perianal abscess' features a fluctuant, erythematous, indurated swelling with constitutional fever.

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