Acute Trombosed hemorrhoids

This is the case of a 62 year-old male that during 12 years have been suffering from internal hemorrhoids grade III hemorrhoids protrude spontaneously and require manual reduction but never seek medical help, suddenly had an acute trombosed internal and external hemorrhoids.

There are two hemorrhoids that are trombosed one is
external and one is internal both are trombosed contain
both internal and external components with acute
thrombosis and strangulation

Are hemorrhoids that have clotted on the inside of the anus
(a ‘thrombus’). These clots form in the veins of the rectum just
under the skin. External hemorrhoids can be seen and/or felt.
Sometimes they are soft. Other times they are hard.