Introduction:
Although anorectal diseases in clinical practice are relatively common, thrombosed external hemorrhoids (TEH) are still a major therapeutic problem. TEH most frequently occurs in subjects with diagnosed hemorrhoidal disease.

Aim:
The aim of this work was to report and analyze a case of TEH.

Case study:
The patient, a 22-year-old male, attended Proctology Clinic with a severe anal pain. He had a history of pain which occurred the day before for the first time in his life. Physical examination showed no abnormalities. Digital rectal examination revealed TEH. Patient consented for incision of TEH under local anesthesia. Following the administration of anesthesia around TEH, incision was made and blood clot was evacuated. After 2 days the patient attended a follow-up appointment in the Proctology Clinic. After the incision was made the pain has resolved. From the time of TEH incision the patient did not receive any pain medication. After 5 months there was no recurrence of the disease.

Results and discussion:
TEH is the cause of severe pain and itching. Major cause of the pain is the increased tension of external anal sphincter muscle. Diagnosis of TEH is made based on anamnesis, physical examination and additional tests. The most important part of a physical examination is digital rectal examination. Early diagnosis of thrombus and initiation of proper, most frequently surgical, treatment is an effective treatment method of this condition.

Conclusions:
Treatment of TEH should be adjusted for each patient individually. The main factor determining the choice of treatment method is patient consent for a surgical intervention under local anesthesia. Excision or incision of the thrombosed hemorrhoid under local anesthesia in patients with TEH is a completely secure method, at the same time with a low number of complications.