Recurrent Trans-Sphincteric Ano-Scrotal Fistula Cured by Kshar Sutra Treatment

Abstract Fistula-in-ano (FIA) with scrotal extension is a rare condition. Because symptoms such as swelling, pain, and discharge are common to several diseases, an ano-scrotal fistula may be misdiagnosed as tuberculosis, a sexually transmitted infection, or Crohn’s disease. The primary challenges include accurately identifying the trajectory of the ano-scrotal fistula and achieving a cure without causing incontinence. This condition is exceedingly uncommon, with only a few cases documented in the medical literature. We report the case of a 36-year-old man with a history of recurrent abscesses at the base of the scrotum. Examination revealed a 9-cm-long trans-sphincteric FIA with scrotal extension. The interior orifice was located at the 12 o’clock position. This case represents one of the rarest presentations of anal fistula with scrotal extension, as it is not associated with any systemic disease or congenital deformity. The patient was treated using Kshar Sutra, a medicinal herbal seton, and has remained completely disease-free for the past 4 years.