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Case Report

An Integrated Approach in the Management of Complex Posterior Horse Shoe Fistula-in-Ano

Tukaram S. Dudhamal, Associate Professor & I/C HOD, Dept. of Shalyatantra, I.P.G.T. & R.A. Gujarat Ayurved University, Jamnagar, Gujarat 361008, India. , Monica Shrestha1 , T.S. Dudhamal2

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Indian Journal of Ancient Medicine and Yoga 10(4):p 153-157, Oct-Dec 2017. | DOI: DOI: https://dx.doi.org/10.21088/ijamy.0974.6986.10417.7

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Abstract

Ksharsutra application in fistulainano takes upper hand in the various surgical modalities available but it has its limitations one of which is long duration of treatment. In this case study, a 45 years old male patient visited Shalya OPD with complaints of intermittent fever, swelling at perianal region, pus discharge from perianal region for 3 months. Patient underwent incision and drainage (I&D) 3 months back. On perianal examination in lithotomy position there were two external opening at 5 and 7 o’clock and a common internal opening at 6 o’clock position. Fibrosed band could be palpated from 5 to 7 o’clock. Routine blood and urine examinations were within normal range. Pus culture showed presence of Escherichia coli (E.coli). Trans rectal Ultrasonography (TRUS) report showed 10cm long “Horse shoe” shaped fistula in perianal region with external opening at 5 and 7 o’clock and internal opening at 6 o’clock, 10mm from anal verge, 20mm and 28 mm long blind branch at 5 and 7 o’clock respectively. Hence, case was diagnosed as Bhagandara (complex posterior horse shoe fistulainano). He was treated by partial fistulectomy with Ksharsutra application along with window technique. Postoperative wound healed within 6 months. Patient faecal continent was maintained and there was no evidence of fistula. Postoperative TRUS showed subcutaneous hypoechoic scar in perianal region between 5 to 7 o’clock positions. So this case highlighted that integrated approach treats the cryptoglandular infection and decreases the duration of treatment.

Keywords: Bhagandara; HorseShoe Fistula; Ksharasutra; PartialFistulectomy. 

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DOI: DOI: https://dx.doi.org/10.21088/ijamy.0974.6986.10417.7

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