Integrated management of multiple fistula-in-ano associated with diabetes mellitus - A Case report

Background- Due to their complex anatomy, high recurrence rate, and lack of conventional protocols, multiple anal fistulas are a unique surgical condition with a variety of therapy options. In cases of multiple fistulas in ano, the Interception of Fistula Track with Application of Ksharasutra (IFTAK) is a minimally invasive procedure that offers a high success rate, promotes quick healing, and minimizes sphincter damage. Materials and methods - A male diabetic patient, age 58, presented with complaints of pain and pus discharge from the right side of the perineal area, associated with fever. Upon examination, there were multiple pus-filled openings in the perianal region combined with significant discomfort. According to modern science and traditional Ayurvedic medicine, the case was identified as multiple fistula in ano and shataponaka bhagandara, respectively. The patient received an integrated treatment plan that included intravenous antibiotics, analgesics for seven days, surgical exploration Integrated management of multiple fistula in ano associated with diabetes mellitus - A Case Report, IFTAK, and oral Ayurvedic medications for a 3 months afterward. Ksharasutra was changed every seven days, and after wounds were left open for secondary healing, a total of four sittings of the sutra were performed. Results- The fistula tracks healed completely after 3 months of treatment with minimal scar formation. Conclusion- The fistula was managed successfully with the integrated approach. Further research in this direction is the need of the hour for generating evidence based results.