COMBINED KṢĀRASŪTRATHERAPY AND KṢĀRAJALA INFILTRATION IN ŚATAPONAKA BHAGANDARA (COMPLEX FISTULA-IN-ANO): A CASE STUDY

Background: Bhagandara, a chronic and recurrent anorectal disorder, is characterized by multiple openings, pus discharge, and pain. It resembles a complex fistula-in-ano in modern surgical terminology. Kṣārasūtra therapy, one of the effective para-surgical measures described by Ācārya Suśruta, offers simultaneous cutting, drainage, and healing of the tract. Kṣārajala infiltration enhances śodhana and ropana actions, providing faster recovery and reducing recurrence. Case-Summary: A 64-year-old male patient presented with multiple perianal openings, pain, and discharge following incision and drainage. Examination revealed multiple external openings with induration. Probing confirmed interconnected tracts, suggestive of a complex fistula (Śataponaka Bhagandara). Routine investigations were within normal limits. The condition was diagnosed as Śataponaka Bhagandara. Intervention: Treatment protocol included VibhitakīKṣārasūtra application weekly and Vibhitakī Kṣārajala infiltration (10 ml) every 3 days for 6 weeks, followed by oral administration of Triphala Guggulu, Saptaviṃśati Guggulu, Abhayāriṣṭa, and Pañcasākara Cūrṇa for 10 weeks. Results: By the third week, 50% symptomatic relief was observed. At 10 weeks, the fistulous tract completely healed with closure confirmed by MRI fistulogram. Pain and discharge ceased, and inflammatory markers improved significantly. Conclusion: Kṣārasūtra therapy combined with Kṣārajala infiltration offers a minimally invasive, safe, and economical treatment for complex fistula-in-ano, achieving effective tract healing and preventing recurrence.