Complex Trans-sphincteric fistula successfully managed with partial fistulectomy using Ksharsutra: A Case Report

Abstract

Bhagandara (Fistula-in-Ano) is explained as one among Ashta Mahagada in Sushruta Samhita. This disease is recurrent in nature which makes it more difficult for treatment. Ksharsutra has been already proved in the management of fistula-in-Ano though Acharya Sushruta has been explained in context to Nadi-Vrana (sinus). In this case report, 70 year old male patient came to Shalya Tantra OPD with complaints of multiple boils at perianal region associated with pain and blood mixed pus discharge since1.5 months. On PRE two external openings were present anteriorly between 12 to 1 o’clock position along with surrounding induration, internal opening palpated at 12 o’clock at dentate line. Inter-sphincteric collection felt between 12 to 3 o’clock with fibrosis in lithotomy position. MR Fistulogram, suggestive of anterior trans-sphincteric fistula-in-Ano. So this complex fistula was treated with partial-fistulectomy with Ksharsutra application under sadal block. Ksharsutra was changed by weekly interval adopting railroad technique. Whitin time period of 8 weeks, wound healed completely and no any recurrence history found in follow up of 2 months.