Long Bilateral Horseshoe-Shaped Anal Fistula (without Internal Opening) Treated by Kshar Sutra: A Rare Case Report

Abstract Anal fistulae can be of different shapes and lengths with multiple openings or branches. Bilateral horseshoe-shaped fistula is a rare and aggressive form of anal fistula. The treatment of the anal fistula has continued a big challenge to date. Only a few cases of a long bilateral horseshoe shape anal fistula without internal opening have been reported. We present a rare case of a 17-cm long bilateral horseshoe-shaped anal fistula with two external openings and without internal openings. The patient was treated using Kshar Sutra (a medicated thread) with weekly thread changes. C-arm imaging guidance was used to insert the thread perfectly in the fistula track. The entire procedure was performed under local anaesthesia. Medicines were not given for infection control. There were no complications after the procedure. The patient was completely cured and fistula-free for 8 years. The Kshar Sutra technique can be an effective alternative treatment to cure fistula- in-ano .