AN INNOVATIVE APPROACH IN THE MANAGEMENT OF HORSE-SHOE FISTULA-IN-ANO WITH IFTAK

Abstract

Anal fistulas and abscess of the ano-rectal region are different manifestations of the same clinical disease. Ischio-rectal abscess usually develops from infection arising in the crypto glandular epithelium lining in the anal canal extension laterally through the external sphincter. Horse-shoe fistula usually have an internal opening in the posterior midline and external anteriorly and laterally to one or both ischo-rectal spaces by way of the deep potential space. The "Parikshepi Bhagandara" described by acharya Vagbhata in astanga hrudaya uttarasthana can be correlated with the Horse-shoe type of fistula. The overall prevalence rate of fistula-in-ano is 8.6 cases/1,00,000 population. In this condition, neither fistulotomy nor ksharasutra treatment alone, are useful hence, there is need of newer innovative surgical techniques to tackle this challenging disease. An integral approach of incision and drainage(I&D) of ischio-rectal abscess of the arms of the horse-shoe fistula with interception from internal opening to IFTAK artificial window and external opening to IFTAK artificial window proves to be successful. An innovative approach was used to manage horse-shoe fistula by making an additional IFTAK window. Ksharasutra was changed weekly and foleys catherter was kept in cavity for drainage as well as for easy wash and dressing the fistulous track healed completely by 2 months.