A Modified Ksharasutra Strategy for Challenging Posterior Horseshoe Abscess with Supralevator Extension – A Case Study

Abstract

Most of the anorectal abscesses are cryptoglandular in origin but may also occur due to trauma or any inflammatory process. Presenting symptoms include pain, swelling, fever, difficulty in urination, and purulent discharge. Patients with a previous history of an anorectal abscess, inflammatory bowel disease, or any trauma may present with more complex abscesses. Supralevator extension occurred due to cephalad extension of intersphincteric or ischioanal abscess or caudal extension of pelvic abscess. Anorectal abscess is correlated with Gudaja Vidradhi which is mentioned in Antarvidradhi by Acharya Sushruta . The management principle in contemporary and Ayurveda science remains same, i.e., incision and drainage. This report presents the case of a 43-year-old male patient diagnosed with a posterior horseshoe abscess with supralevator extension, with a previous history of perianal abscess 5 years back. The patient was intervened with Bhedana and Visravana (incision and drainage) of abscess followed by the modified Ksharasutra technique which resulted in complete wound healing by 9 postoperative weeks. The patient showed better compliance, and there was no recurrence or incontinence noted up to 20 months of longer follow-up period which shows the potentiality and better effectiveness of the Ksharasutra technique.