Integrated management of Anterior Horseshoe Fistula in Ano w.s.r to Pittaj Vidradhi and Parikshepi Bhagandara: A Case Report
DOI:
https://doi.org/10.70066/jahm.v14i1.2471Keywords:
Bhagandar (fistula in ano), fistuloctomy,, Horseshoe fistula,, Ksharasutra, Case reportAbstract
Background
Horseshoe Fistula in Ano (HSFA) is a type of Fistula in Ano which occurs as a complication of deep postanal space abscess. HSFA presents with higher reoccurrence rate and affects 15% of patients suffering from Fistula in Ano. The protocols for HSFA have multiple risk, complications, including anal incontinence. Ksharasutra (Medicated thread) is a well-accepted procedure having faster recovery and reduced risks of complications.
Clinical Findings
A 21-year-old female patient presented with complaints of severe pain and swelling in perianal region since past 3 days associated with fever and chills. On examination bilateral perianal swelling with prominent redness and tenderness over right buttock seen. Preoperatively it was observed that the contralateral side perineal spaces were involved anteriorly forming Horseshoe shaped abscess.
Intervention
Bhedana Karma (incision and drainage) was done over perianal area, followed by partial fistulotomy along with Ksharasutra ligation (KSL) at 12 o’clock position to facilitate proper drainage. K.S was changed weekly with rail-road technique. Regular wound dressing and Ayurvedic medicines were advised. Complete healing of the tract was attained within 12 weeks without any reoccurrence or complications observed till date. (4 years)
Outcome
The Fistula tracts healed completely with complete closure of wound within 12 weeks.
Conclusion
This case of HSFA was successfully managed with an integrated approach, which included surgical procedures (incision and drainage of abscess + partial fistulotomy + KSL) and oral Ayurvedic medicines with complete wound healing and no complications.
References
Abcarian H, editor. Anal Fistula [Internet]. New York, NY: Springer New York; 2014 [cited 2025 Dec 8]. Available from: https://doi.org/10.1007/978-1-4614-9014-2 p. 13-21
Ramanujam PS, Prasad LM, Abcarian H, Tan AB. Perianal abscesses and fistulas. Diseases of the Colon & Rectum [Internet]. 1984 Sep;27(9):593-7. Available from: https://doi.org/10.1007/bf02553848
Killedar R, Solankure K, Shindhe PS, Patel D. Integrated management of multiple fistula-in-ano associated with diabetes mellitus - A Case report. JAHM [Internet]. 2025 May;13(4):143-50. Available from: https://jahm.co.in/index.php/jahm/article/view/1836
Toshikhane H, Wali A, Dongargaon T, Shilpa M. Innovative approach in the management of horse-shoe fistula-in-ano with Kṣārasūtra. Anc Sci Life [Internet]. 2015 Jan-Mar;34(3):162-166. Available from: https://doi.org/10.4103/0257-7941.157161
Gonzalez-Ruiz C, Kaiser AM, Vukasin P, Beart RW, Ortega AE. Intraoperative Physical Diagnosis in the Management of Anal Fistula. The American surgeon. [Internet].2006 Jan;72(1):11-15.
Available from: https://doi.org/10.1177/000313480607200103
Ambikadutta Shastri (editor). Commentary: Ayurveda Tattva Sandipika on Susruta Samhita of Maharsi Susruta, Sutrasthana, chapter 33, verse no.4, 14th edition, Varanasi; Chaukhambha Sanskrit Sansthan;2003;126
Brahmanand Tripathi (editor). Commentary: Nirmala on Astanga Hrdayam of Srimadvagbhata, Uttarsthana, chapter 28, verse no. 14, reprint edition, New Delhi; Chaukhambha Sanskrit Pratishthan;2022;1094
Ambikadutta Shastri (editor). Commentary: Ayurveda Tattva Sandipika on Susruta Samhita of Maharsi Susruta, Nidansthana, chapter 9, verse no.8, 14th edition, Varanasi; Chaukhambha Sanskrit Sansthan;2003;126
Ambikadutta Shastri (editor). Commentary: Ayurveda Tattva Sandipika on Susruta Samhita of Maharsi Susruta, Chikitsasthana, chapter 16, verse no.35, 14th edition, Varanasi; Chaukhambha Sanskrit Sansthan;2003;126
Garg P, Kaur B, Yagnik V, Menon G. Extreme horseshoe and circumanal anal fistulas-challenges in diagnosis and management. Tzu Chi Med J [Internet]. 2021 Apr;33 (4): 374-379. Available from: https://doi.org/10.4103/tcmj.tcmj_287_20
KT S, V R R. Analysis of efficiency and pain level in the management of Fistula-in-Ano with sliding Ksharasutra technique - A Pilot Study. JAHM [Internet]. 2025 Mar;13(2):1-9. Available from: https://jahm.co.in/index.php/jahm/article/view/1591
Nivedhitha N. Post-Operative Antibiotics and Analgesics In Infection Control and Pain Management-Decision Analysis. Int J Dent Oral Sci [Internet]. 2021 Mar ;08(05):2563-2569. Available from: https://doi.org/10.19070/2377-8075-21000502
Laxmikant SD, Kumari S, Prasad B. Integrated Treatment Approach in the Management of Complex High Trans-Sphincteric Fistula-in-Ano (Bhagandara): A Case Report. JAHM [Internet]. 2025 Nov;13(10):98-107. Available from: https://jahm.co.in/index.php/jahm/article/view/2240
Srujana SP, Shindhe PS, Kumbar VM, Manjarekar S. Antibiofilm activity of Kashaya Upakrama (Shasti Upakrama): An exploratory study on common wound isolates. JAHM [Internet]. 2025 May;13(4):47-59. Available from: https://jahm.co.in/index.php/jahm/article/view/1828
Santosh YM, Gupta U, Pawar T. Ayurvedic management of Nicolau Syndrome W.S.R to Agantuja Vidhradhi and Kotha – A case report. JAHM [Internet]. 2025 Jul;13(6):155-61. Available from: https://jahm.co.in/index.php/jahm/article/view/1824
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