Integrated management of Tubercular Fistula-in-ano: A case study.
Introduction: Tubercular fistula-in-ano is one of the extrapulmonary manifestations of Tuberculosis. Around 10-12% cases of Fistula-in-ano have been found to be tubercular in origin. This usually occurs along with pulmonary tuberculosis but can also occur in the absence of pulmonary infection. General management of fistula-in-ano through Ayurveda can be performed along with anti-tubercular chemotherapy in such cases.
Case Report: A 24 year old male with Tubercular fistula-in-ano has been treated with Partial fistulectomy with Ksharasutra application and Anti-tubercular drugs per orally along with other oral medications and local treatment of the wound. Patient got relief from all his previous signs and symptoms along with complete healing of the fistulous wound without any adverse effects. It took 1 year and 2 months for the same without recurrence till the date.
Discussion: Fistula-in-ano has been well controlled with the Ksharasutra application which acts as a cutting as well as draining seton, where unhealthy granulation is destroyed by liquefaction necrosis of Kshara followed by wound healing. Tubercular infection is well controlled by the anti-tubercular drugs.
Harland RW, Varkey B. Anal tuberculosis: report of two cases and literature review. Am J Gastroenterol. 1992; 87:1488–1491
Arora VK, Chopra KK. Extrapulmonary tuberculosis. Indian JTuberc. 2007;54:165–7.3
Sahu M, A manual on fistula-in-ano and Ksharsutra therapy, 1st edition, National resource centre on Ksharsutra therapy, Varanasi, 2015. p 154-155
Corman M, Corman’s colon and rectal surgery, 6th edition, Lippincott Williams &Wilkings, a Wolters Kluwer, Philadelphia, 2013. p 417
Mishra JK, Sahu M, Sharma A. Non cryptoglandular fistula inano. In: Sahu M, editor. A manual on fistula in anoandksharsutra therapy. Varanasi (India): National ResourceCenter on Ksharsutra Therapy; 2015. p. 154–63.6.
Gupta PJ. Tuberculosis fistulas. In: Abcarian H, editor. Analfistula: principles and management. New York: SpringerScience + Business Media; 2014.
Sahu Manoranjan, Mishra Jai Krishna, Sharma Ashish, Fatmi Uzma. A prospective study on tubercular fistula in ano and its management. J. Coloproctol. (Rio J.) [Internet]. 2017 Sep. [cited 2020 Dec 18] ; 37( 3 ): 211-215. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S2237-93632017000300211&lng=en. https://doi.org/10.1016/j.jcol.2017.04.005.
Le Bourgeois PC, Poynard T, Modai J, Marche C, Avril MF, Chaput JC. Peri-anal ulceration. Tuberculosis should not be overlooked. Presse Med. 1984;13:2507–2509
Candela F, Serrano P, Arriero JM, Teruel A, Reyes D, Calpena R. Perianal disease of tuberculous origin: report of a case and review of the literature. Dis Colon Rectum. 1999; 42: p110–112.
Musch E, Tunnerhoff-Mucke A. Tuberculous anal fistula in acquired immunologic deficiency syndrome. Z Gastroenterol. 1995; 33: p440–444.
Kraemer M, Gill SS, Seow-Choen F. Tuberculous anal sepsis: report of clinical features in 20 cases. Dis Colon Rectum. 2000; 43:1589–1591
Acharya JT. Susrutha Samhita with Nibandhasangraha commentary of Dalhana. Reprint ed. Varanasi (India): Chaukambha Sanskrit Sansthan; 2009.p.47
Charaka Samhita chikitsasthana ,: Vidyotini Hindi commentory by Pt. Kashinath Sharma and Dr.G.N. Chaturvedi, chapter 12 sloka number 97 Chaukhambha Sanskrit sansthan, Varanasi (1975)
Murthy srikanthaK.R.Susrut Sushruta Samhita Vol 1, ChikitsaSthana,Chapter 17,Bhagandarachikitsa,Shloka 29 ChaukambhaOrientalia,Varanasi, Reprinted Edition:2016
The Ayurvedic Formulary of India, Government of India; 8.2 Ksharasutra; p213
Hegde L.Prakash, A TextBook of DravyagunaVijnana, 1st Edition,;NewDelhi,Chaukhamba Publication Vol II 2016 Haridra, p333
Shah. RK: Effect of SnuhiKsheera Extract (Triterpene) Kshara Sutra in Fistula-in-ano, M.D., (Ay.) Thesis, I. M.S., B.H.U., (1994)
Classic articles in colon and rectal surgery. Hippocrates: on fistulae. Corman ML Dis Colon Rectum. 1980 Jan-Feb; 23(1):56-9.
Classic articles in colonic and rectal surgery. John Arderne 1307-1380(?). Treatises of Fistula in Ano. Dis Colon Rectum. 1983 Mar; 26(3): p197-210
Williams N, O’Connell P, Mccaskie; Baily & Love’s Short practice of surgery; 27th edition; CRC Press, 2018; p1367
ADONI L. STREPTOMYCIN IN TREATMENT OF CUTANEOUS TUBERCULOSIS. AMA Arch Derm Syphilol. 1953; 68(4):378–381. doi:10.1001/archderm.1953.01540100018002
Peshala KKVS, Sahu M, Singh L. A study of Anal sphincter tone in acute fissure in ano patients treated with Mahanarayana oil. Int. J. Res. Ayurveda Pharm. 2014;5(3): p318-321 http://dx.doi.org/10.7897/2277-4343.05365
Copyright (c) 2021 International Journal of Ayurveda and Traditional Medicine
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
IJATM follows the following Terms and License of the manuscript under Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) where Author and Journal are can Share — copy and redistribute the material in any medium or format and Adapt — remix, transform, and build upon the material, and it is Non-Commercial.