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Management of rare, low anal anterior fistula exception to Goodsall's rule with Kṣārasūtra.

Shindhe PS - Anc Sci Life (2014)

Bottom Line: Typically, fistula has two openings, one internal and other external associated with chronic on/off pus discharge on/off pain, pruritis and sometimes passing of stool from external opening.This affects predominantly male patients due to various etiologies viz., repeated peri-anal infections, Crohn's disease, HIV infection, etc., Complex and atypical variety is encountered in very few patients, which require special treatment for cure.We would like to report a complex and atypical, single case of anterior, low anal fistula with tract reaching to median raphe of scrotum, which was managed successfully by limited application of kṣārasūtra.

View Article: PubMed Central - PubMed

Affiliation: Department of Shalya Tantra, KLE University's Shri. B. M. Kankanawadi Ayurveda Mahavidyalaya, Shahapur, Belgaum, Karnataka, India.

ABSTRACT
Anal fistula (bhagandara) is a chronic inflammatory condition, a tubular structure opening in the ano-rectal canal at one end and surface of perineum/peri-anal skin on the other end. Typically, fistula has two openings, one internal and other external associated with chronic on/off pus discharge on/off pain, pruritis and sometimes passing of stool from external opening. This affects predominantly male patients due to various etiologies viz., repeated peri-anal infections, Crohn's disease, HIV infection, etc., Complex and atypical variety is encountered in very few patients, which require special treatment for cure. The condition poses difficulty for a surgeon in treating due to issues like patient hesitation, trouble in preparing kṣārasūtra, natural and routine infection with urine, stool etc., and dearth of surgical experts and technique. We would like to report a complex and atypical, single case of anterior, low anal fistula with tract reaching to median raphe of scrotum, which was managed successfully by limited application of kṣārasūtra.

No MeSH data available.


Related in: MedlinePlus

External opening of fistula at scrotum during inspection
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Figure 1: External opening of fistula at scrotum during inspection

Mentions: On examination, the patient's vital parameters were stable. On local examination, there were two visible external openings on the scrotum anteriorly on median raffe [Figure 1]. The internal opening was not palpable on per rectal examination. Both the external openings were four centimeters apart on palpation. There was hard indurated swelling with tenderness possibly due to chronic infection and heavy usage of antibiotics (antibioma), both external sinuses were nonmovable suggesting that they were adhered to hard indurated swelling. Probing was done to ensure direction and position of internal opening, but probing was not possible due to induration.


Management of rare, low anal anterior fistula exception to Goodsall's rule with Kṣārasūtra.

Shindhe PS - Anc Sci Life (2014)

External opening of fistula at scrotum during inspection
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4264308&req=5

Figure 1: External opening of fistula at scrotum during inspection
Mentions: On examination, the patient's vital parameters were stable. On local examination, there were two visible external openings on the scrotum anteriorly on median raffe [Figure 1]. The internal opening was not palpable on per rectal examination. Both the external openings were four centimeters apart on palpation. There was hard indurated swelling with tenderness possibly due to chronic infection and heavy usage of antibiotics (antibioma), both external sinuses were nonmovable suggesting that they were adhered to hard indurated swelling. Probing was done to ensure direction and position of internal opening, but probing was not possible due to induration.

Bottom Line: Typically, fistula has two openings, one internal and other external associated with chronic on/off pus discharge on/off pain, pruritis and sometimes passing of stool from external opening.This affects predominantly male patients due to various etiologies viz., repeated peri-anal infections, Crohn's disease, HIV infection, etc., Complex and atypical variety is encountered in very few patients, which require special treatment for cure.We would like to report a complex and atypical, single case of anterior, low anal fistula with tract reaching to median raphe of scrotum, which was managed successfully by limited application of kṣārasūtra.

View Article: PubMed Central - PubMed

Affiliation: Department of Shalya Tantra, KLE University's Shri. B. M. Kankanawadi Ayurveda Mahavidyalaya, Shahapur, Belgaum, Karnataka, India.

ABSTRACT
Anal fistula (bhagandara) is a chronic inflammatory condition, a tubular structure opening in the ano-rectal canal at one end and surface of perineum/peri-anal skin on the other end. Typically, fistula has two openings, one internal and other external associated with chronic on/off pus discharge on/off pain, pruritis and sometimes passing of stool from external opening. This affects predominantly male patients due to various etiologies viz., repeated peri-anal infections, Crohn's disease, HIV infection, etc., Complex and atypical variety is encountered in very few patients, which require special treatment for cure. The condition poses difficulty for a surgeon in treating due to issues like patient hesitation, trouble in preparing kṣārasūtra, natural and routine infection with urine, stool etc., and dearth of surgical experts and technique. We would like to report a complex and atypical, single case of anterior, low anal fistula with tract reaching to median raphe of scrotum, which was managed successfully by limited application of kṣārasūtra.

No MeSH data available.


Related in: MedlinePlus