A Rare Case of Complex Anal Fistula (shambukavarta bhagandara) Resembling Simple Anal Fistula: Success through Modified Ksharasutra Therapy

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BSTRACT

Despite various treatment modalities, anal fistula remains a burdensome disease for surgeons, and when presented at an advanced stage, it becomes more challenging. At times, the presenting clinical features may misdiagnose a complex case of anal fistula as a simple one, which is one of the reasons for surgical failure. Proper diagnosis with appropriate evaluation and investigation helps to confirm the diagnosis of such cases and facilitates the prognosis of the disease. A male patient aged 50 years presented with complaints of pus discharge from a boil at the posterior perianal region for the last 2 months. On baseline, clinical assessment, external and internal opening was at 6 o’clock position, while an induration was felt from 3 o’clock to 9 o’clock position, suggesting bilateral ischiorectal collections. On inspection, it looked like a simple case, but induration at the posterior perineal region indicated magnetic resonance imaging (MRI), which revealed grade IV complex fistulous tract involving bilateral ischiorectal fossa with a collection of pus. Patient underwent modified Ksharasutra treatment, which involved a minimal invasive approach incorporating adequate drainage of pus collection followed by regular dressings with Ayurvedic medicaments to achieve Shodhana (cleaning) and Ropana (wound healing). It took approximately 4 weeks to achieve complete healing with resolution of the symptoms. Clinical examination also confirmed the healing of the wound with no evidence of any discharge and tenderness. This method took less time to cure the condition when compared with the conventional method, which usually takes 10–12-week period. Modified technique used in this case achieved resolution within 4 weeks along with minimal damage to the tissues in the anal region.