MANAGEMENT OF ANAL FISTULA USING SNUHI-KSHEERA BASED KSHAR SUTRA: A CLINICAL CASE REPORT

Abstract

Background: Fistula-in-ano (Bhagandara) remains a challenging colorectal condition due to high recurrence rates and the risk of anal sphincter damage leading to fecal incontinence. Traditional wide surgical excisions often compromise sphincter tone. This case study evaluates the clinical efficacy of a minimally invasive parasurgical intervention utilizing Snuhi-Ksheera (latex of Euphorbia neriifolia) and Apamarga Kshara (Achyranthes aspera caustic alkali) coated Kshara Sutra (medicated thread) for the management of a chronic fistulous tract. Case Presentation: A 40-year-old male presented with a three-year history of a recurrent perianal boil accompanied by intermittent purulent, blood-mixed discharge, local discomfort, itching, and chronic constipation. Clinical and probe examinations revealed a primary, transsphincteric fistula-in-ano with two external openings at the 3 and 4 o'clock positions, communicating with a single internal opening at the 3 o'clock position. Intervention: The patient underwent primary threading and chemical debridement of the fistulous tract under local anesthesia using a specialized Snuhi-Ksheera based Apamarga Kshara Sutra. The medicated thread was changed sequentially on a weekly basis for 12 weeks. Post-operative conservative management included oral administration of Triphala Guggulu, Hingwashtak Churna, and Triphala Churna, supplemented with rectal instillation of Jatyadi Taila and lukewarm sitz baths with Tankan Bhasma. Outcome: Pus and blood discharge ceased completely within the first 2 weeks of intervention. Healthy granulation tissue formation was observed across subsequent changes, achieving complete tracking, chemical curettage, and healing of the fistulous tract within 3 months (12 weeks). The structural integrity and functional tone of the anal sphincter were completely preserved, with no post-operative incontinence. No recurrence was noted over a one-year follow-up period. Conclusion: Snuhi-Ksheera based Apamarga Kshara Sutra therapy provides an effective, safe, low-cost, and sphincter-preserving surgical alternative for managing transsphincteric fistula-in-ano, demonstrating excellent long-term track obliteration without anatomical or functional morbidity.