Integrative management approach of Shambukavrata Bhagandara (Complex Trans-Sphincteric Fistula): A case report
DOI:
https://doi.org/10.70066/jahm.v14i6.2796Keywords:
Ayurveda, Bhagandara, Case Report, Fistula in ano, kshara sutra, Shambukavrata, Trans-sphinctericAbstract
Background: Fistula in Ano is defined as an abnormal tract with an external opening in perianal skin and internal opening in anal canal. It presents with pain and intermittent pus discharge as common complaint. Trans-sphincteric fistula is a complex type of fistula which originates from abscess in ischio-rectal fossa. Similarly, in Ayurveda tridoshaja or shambukavarta bhagandara have curvilinear track resembling curves of conch shell. Management of this type of fistula is challenging and has high recurrence risk with sphincter injury and hampers quality of life. With integrative approach of contemporary and ayurvedic management including Apamarga kshara sutra (Medicated thread) can ensure early recovery, decreased recurrence and reduced complication risks with improved quality of life. Clinical Findings: A male patient aged 54 years presented with complaints of pain and pus discharge from anal region for past 8 months. He was previously operated twice with conventional method. On examination, external opening and perianal abscess at 5 O’clock position. Provisional diagnosis of Trans-sphincteric fistula was made on basis of examination and scans. Intervention: Partial fistulectomy was done followed by Apamarga kshara sutra ligation done of remaining tract. Regular wound dressing, sitz bath and weekly kshara sutra was changed. Ayurvedic medicine along with diet and lifestyle modifications were also advised. Outcome: Complete recovery with this approach was achieved in 22 weeks of time period with average unit cutting time of 1 cm/week with Apamarga kshara sutra. Primary tract decreased from 10cm to 0 cmNo complaints of any complication were reported post recovery. Conclusion: This case of complex long curvilinear fistulous tract of 10 cm length healed completely in 22 weeks with this integrative approach. Patient reported no adverse effect from the treatment received. This approach had good healing, improved quality of life and had no recurrence over 5 months of follow up.
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