This patient has been treated with scleortherapy by his doctor for years. Now an incision has been made because of "anal thrombosis". Fatal mistake. The result was uncontrollable bleeding, an attempt to stop this was made with a suture (see suture at 7 clock). The patient is now in the proctology inpatient ward.
Such a severe case can not be treated by sclerotherapy or rubber band ligation! Surgical treatment like (stapled) hemorrhoidectomy is necessary.