Introduction

Rectovaginal fistula refers to abnormal communication between ant. Wall of rectum and posterior wall of vagina. In ayurveda fistula is mentioned as bhagandar and treatment of fistulous track with ksharsutra is mentioned in sushrut Samhita. The tremendous properties and successful result of kshar on dushtavran is used in the treatment of fistula. With the help of this treatment rate of recurrence of fistula is minimized successfully.

Case study –

A female patient of age 30 years had complaints of swelling and pain over vaginal n perianal region from 4 months. Gradually pus discharge started from vaginal region and associated etching at vaginal and perianal region from 3 months. she was also suffering from generalized weakness with mild fever. She was taken medicine outside the institute but does not cured so she came to GNT hospital for further evaluation n management.

Patient identification -

Name – X. Y. Z.

Age –30 years/female

Marital status : Married

Occupation : housewife

Social Class : Lower Middle

Address : camp road; dist – Amaravati

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 – Within normal range.
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 11 o clock and in vegina.

Puss discharge found in anal region on PR and veginal region.

Vran pariksha type – Dushtavrana

Hetu – Nija

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

Vranopadravas –

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

Vranpanchak :

1. Akruti –Tenderness at 11 o’clock. Irregular.
2. Gandha – Foul smell evident with pus discharch.

1. Vrana – not seen externally .external opening located at posterior forchhet.
2. Strava – frank pus discharge.
3. Vedana – Burning sensation at anal site, pain and tenderness.

Aim –

To study the case of vaginorectal fistula and its ayurvedic management.

Objective –

1. Study the vaginorectal fistula with ayurvedic management.
2. To decrease the recurrence rate of fistula and complete excision of fistulous track.
3. To minimize the length of fistulous track with ksharsutra application and improving the quality of cutting and healing at the same time.

Case study – Interventional single case study.

Duration of study – 60 days.

Methods –

1. Examination –

Under all aseptic precaution examination of anal region and veginal region done.

External opening located at posterior forchhete of vagina.

Tenderness of perianal and vaginal area was present.

1. Probing and threading –
2. Under all aseptic precaution local anaesthesia given at anal and vaginal region with lignocaine and adrenaline 2% injection.
3. One finger anal dilation done with xylocaine 2% jelly.
4. Part painted with betadine and draping done.
5. Probe inserted from ext. opening at vagina and removed from 11 o’clock at perianal region and threading done with barbour thread no. 20.
6. Again probe inserted from 11 o’clock and removed from anal canal and threading done.
7. Barbour thread change with  Ksharsutra on next day. And then on each 8 day of difference.

Medication –

Inj. T. T. 0.5 ml IM stat.

Isona poweder 1 tsf with warm water hs.

Syp. Arsha 2 tsf BD

Jatyadi tail basti

Hot sits bath.

Discussion

With the help of ksharsutra 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 chedan and debridgement of pus by lekhan and simultaneous granulation of track by ropan is carried out day by day.