Abstract

A CASE REPORT OF A COMPLEX TRANSPHICTERIC FISTULA-IN ANO AND ITS MANAGEMENT THROUGH PARTIAL FISTULOTOMY FOLLOWED BY KSHARA SUTRA

Dr. Sanjana S.* and Dr. Sheshashaye B.

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Abstract

Acharya Susrutha has mentioned Bhagandara as one among Asta Mahagada.[1] Nirukti of Bhagandara is described in gada nigraha as “Vrushanaasanayormadhyapradesho bhagamuchyate, tameva dhaarayettasmaadbhagandara iti smrutaha”. The darana of vrushanasana madhya sthita bhaga is Bhagandara.[2] Acharya Sushruta says “Bhagagudabasti pradeshadaaranat cha bhagandara iti uchyante, abhinnaaha pidakaha, bhinnastu bhagandaraha”- Pidakas formed at bhaga, guda and basti pradesha undergoes suppuration, bursts open and makes an opening known as Bhagandara.[3] Acharya Susrutha classifies Bhagandara into Shataponaka, Ushtragreeva, Parisravi, Shambookavarta and Unmargi.[4] In Contemprory science it is compared to Fistula-in-ano. It is an inflammatory track with external opening in the perianal skin and internal opening in the rectum or anal canal. The mean incidence of non-specific fistula in ano is 8.6 cases/1,00,000 population,12.3 for males and 5.6 for females. It usually begins from a perianal abscess caused by cryptoglandular infection. It burst spontaneously and forms Fistula-in-ano.[5] Transphincteric fistula is a type of fistula in which it extends through both internal and external anal sphincters. Goodsall‟s rule a clinical tool used to predict the the course of fistula in the anus. A 42 years old male patient approached to Shalya Tantra OPD with complaints of pus discharge from the anal region and was feeling discomfort in sitting posture and was examined thoroughly and was diagnosed as Fistula-in-ano for which partial fistulotomy followed by Kshara sutra was done and the Kshara sutra was changed once in a week and wound was healed completely.

Keywords: Bhagandhara, Kshara sutra, Fistula in ano, Partial fistulotomy.