Integrated Management of complex Fistula-in-Ano in a Patient with Ulcerative Colitis Using Kshara Sutra: A Unique Case Study

Introduction: Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by mucosal inflammation of the colon and rectum often leading to debilitating symptoms and complications. Fistula-in- Ano is a rare complication of UC, which is an abnormal tract connecting the anal canal to the skin surrounding the anus, further complicating management and impairing patients' quality of life which poses significant challenges in management due to its chronic and recurrent nature. Kshara Sutra, an Ayurvedic parasurgical procedure involving the use of medicated thread, has shown promising results in the treatment of complex Fistula-in-Ano in a patient with ulcerative colitis. Aim: To evaluate the efficacy of Kshara Sutra in the management of complex Fistula-in-Ano in a patient with Ulcerative colitis. Material and Methods: A Hindu, married 56 yrs. old male patient came in Shalya Department of Naradevi Ayurveda Hospital, Kathmandu Nepal with a chief complaints of recurrent episodes of bloody diarrhea, abdominal pain, and perianal discharge over a span of four years. Diagnostic workup revealed extensive colonic involvement consistent with UC on colonoscopy and imaging confirmed the presence of a fistula-in-ano. The patient was diagnosed as a case of Fistula-in Ano with clinical findings & examination done. Then Kshara sutra Ligation was planned along with internal medications. Results/Discussions: After 6 months of treatment, result was achieved remarkably. Conclusion: This case highlights the potential efficacy and safety of Kshara Sutra therapy as an adjunctive and safest treatment modality for managing complex Fistula-in-Ano in patients with underlying ulcerative colitis.