Integrated management of Anterior Horseshoe Fistula in Ano w.s.r to Pittaj Vidradhi and Parikshepi Bhagandara: A Case Report

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.