A man presented with a purplish swelling at the anal area. It is acutely painful and he complains of constipation for the last 2 months. What is the most appropriate management?

The key is B. I&D + antibiotics. [Excision is the method which is done in case of hemorrhoid not incision. This is a case of perianal hematoma which when clotted is treated by incision and left open with excellent result of healing with aids of antibiotics prophylaxis. It occurs in case of constipation. Answer is B. Incision and drainage + antibiotics. In acute case prior to thrombosis can be treated with evacuation with syringe].