Introduction

Fistula in ano is very common disease in anorectal practices. In pediatric patient it is generally found as a congenital disease or as a result of perianal abscess secondary to trauma and foreign body. It is abnormal conection between anus and perianal skin. In ancient days, acharya sushruta had explained this disease as bhagandara and told various treatments such as probing and threading. In ayurveda ksharsutra aplication is one of the very successful treatment. Kshar has various properties as chedan, bhedan, lekhana, ropan, pachan which helps in fistula for simultaneous cutting and healing of track.

Case study :A female child of age 10 years. Having complaints of pain at rt. Side of anal region and pus discharging opening since 2 months. She had trauma and had foreign body (stick) at the site of tenderness from 3 months before. Previously she was treated with medicines but does not cured so came in GNT hospital and admitted in ward no. 4 for further evaluation and management.

Patient identification:

Name – X. Y. Z.

Age – 10 years/female  

OPD no. - 15139

Marital status: not married (child)

Occupation: student

Social Class: Lower Middle

Address: varni ; dist –  yavatmal.

General examination:

G. C. – Moderate

Temperature – Mild febrile

Pulse – 72/min

B. P. – 130/80 mm of hg

S/E :   RS - clear

CVS – S1 S2 clear, NAD.

CNS – conscious oriented, NAD.

Investigations :

1. CBC and ESR – afeb
2. HIV and HBsAG – Negative
3. BT, CT – Within normal range.
4. Blood Sugar Level – variable; HBA1C – moderately increase
5. Sr. Creatinin – Within normal range.
6. Blood Urea – Within normal range.
7. BUN – Within normal range.
8. LFT - Within normal range.

Local Examination :

Swelling and tenderness found in perianal region at 9’o clock with discharging external opening .

Vran pariksha type – Dushtavrana

Hetu –Agantuja

Vran-ashraya (Adhishthan ) – twak, rakta, mansa, meda.

Vranopadravas –

1. Vranasya – Foul smell, mild pus discharge, pain at perianal site, Tenderness.
2. Vranitasya –Daurbalya,gudpradeshi kartanvat vedana and shoth, Kshudhamandya, nidralpata.

Vranpanchak :

1. Akruti – External opening at 9 o’clock, Irregular. And having foreign body (stick) in it.
2. Gandha – Foul smell evident with pus discharch.

1. Vrana – External opening at 9 o’clock with pus discharge.
2. Strava – mild pus discharge.
3. Vedana – Burning sensation at anal site, pain and tenderness.

Aim :

To study the case of fistula in ano in child and its ayurvedic management.

Objective –

Study the fistula in ano with Ayurvedic  management.

To decrease the recurrence rate of fistula and complete excision of fistulous track.

To minimize the length of fistulous track with ksharsutra application and perform cutting and healing at the same time with minimum scar.

Case study : Single case study.

Duration of study: 60 days.

Methods :

1. Examination –

Under all aseptic precaution examination of anal canal and perianal region done.

External opening located at 9 o’clock approx. 2 cm away from anal canal.

Tenderness of perianal area was present.

1. Probing and threading –

Under all aseptic precaution spinal anaesthesia given.

Part painted with betadine and draping done.

Two finger anal dilation done with xylocaine 2% jelly.

Incision taken at ext. opening at 9 o’clock and foreign body (small stick) removed from it.

Probe inserted from 9 o’clock and removed from anal canal and threading done with barbour thread no. 20.

Another probe inserted from 10 o’clock and removed from anal canal and threading done.

Heamostasis achived.

Cleaning and dressing done.

Medication –

Inj. T. T. 0.5 ml IM stat.

From second day,

Barbour thread is replaced by udumber ksheersutra. And changes it after every 10 days.

Isona poweder 1 tsf with warm water hs.

Syp. Arsha 2 tsf BD

Jatyadi tail basti

Hot sits bath.

Discussion

It was observed that there was significant relief in symptoms of fistula in ano and very effective healing was observed after each follow ups.

Result:

With the help of Udumbar ksheersutra application simultaneous cutting and healing of fistulous track done with minimum scar left behind.

Conclusion

In ayurveda, many properties of ksharsutra application had told in Samhita granthas in disease like arsha, arbud, bhagandar,etc. Shocking properties of kshar like chedan, bhedan,lekhan, ropan, dahan had explained in such granthas.So with the help of ksharsutra cutting of fistulous track by bhedan and debridgement of pus by lekhan and simultaneous granulation of track by ropan is carried out day by day.