A case report of primary complex anal fistula with six external openings (Shataponaka bhagandara) treated with interception of fistulous tract with application of Ksharasutra technique

Abstract

Complex anal fistulae, particularly those with six external openings, are rare, with limited documented cases in medical literature, highlighting the clinical novelty of such presentations. Managing these complex fistulae possesses a significant challenge, often requiring intricate surgical procedures that carry a heightened risk of postoperative damage and recurrence, with traditional approaches potentially compromising patients’ quality of life due to the risk of anal incontinence. In this report, a unique case of a 65-year-old male admitted with recurrent perianal boils and on-and-off pain fortwo years is presented. Visual and digital rectal examinations revealed a complex fistula-in-ano with six external openings, emphasizing the rarity of such cases. Conventional treatments were deemed suboptimal for this complex presentation. The patient underwent the Interception of the Fistulous Tract with Application of Ksharasutra (IFTAK) procedure, involving the interception of the fistulous tract and the application of Ksharasutra. Postoperative care included sitz bath, topical application of Jatyadi taila, and oral administration of Triphala guggulu. The patient’s recovery was marked by a gradual reduction in discharge, drying of external openings, and complete healing within eight weeks, with no recurrence observed at the six month follow-up. The IFTAK procedure proves to be a promising and effective intervention for managing rare cases of complex anal fistulae with multiple external openings, showcasing its potential in achieving satisfactory outcomes and rapid wound healing.