IFTAK - An Innovative Technique for managing Shambukavarta Bhagandara (Posterior Horseshoe Fistula-In-Ano) - A Case Report

Abstract

Fistula-in-ano is an abnormal tract connecting the anal canal to the perianal skin, which is usually due to cryptoglandular infection. Although advanced surgical techniques are available, management of horseshoe fistula has very low success rates. Interception of fistulous tract with application of Ksharasutra (IFTAK) is an emerging technique to manage horseshoe fistula-in-ano. A 34-year-old female patient presented with pus discharge from right perianal area for 4 months. local examination revealed two external openings in perianal area at 7 & 3 o’clock positions (approximately 6cm and 4cm from anal verge). Induration and tenderness felt at posterior midline just above dentate line. It was diagnosed as a Shambukavarta Bhagandara (posterior horseshoe fistula-in-ano) and managed by interception of fistulous tract with application of Ksharasutra (IFTAK) technique. Fistulous tract was completely healed by 6 weeks with minimum discomfort. No recurrence was observed in 2 years follow up period. IFTAK is a safe, ambulatory, sphincter preserving technique for horseshoe fistula-in-ano.