An approach towards Complex Long Tract with Multiple Opening Fistula-In-Ano through Kshara Sutra - A Case Report

Abstract

Generally, fistulectomy is an acceptable surgical approach for treating a simple or low trans-sphincteric fistula. But in case of long fistulous tract with multiple external opening fistulectomy is not an adequate surgical procedure because of multiple and large size wounds. We present a case of a complicated fistula-in-ano with a low and a trans-sphinteric element that opens radially from the external opening to the anal canal. A 45-years-old man with a chronic discharging fistula, on clinical examination opening externally at 9 o’ clock position at gluteal region approximately 15 cm away from anal verge and internal opening also at 9 o’ clock position. Another external opening at 5 o’ clock position and internal opening found at 6 o’ clock position. He experienced discharge and pruritus for the previous 6 months and had been on antibiotics. The low fistulous tract from 5 to 6 o’ clock position was curettaged and Kshara was applied. The long fistulas were treated by the Kshara Sutra and multiple simple threads (linen no. 20) application method was adopted. The wound healed fully in 45 days and currently the patient is asymptomatic and has full continence at 6 months of follow-up.