Recurrent Inter-Sphincteric Pediatric Fistula in Ano Cured by Kshar Sutra (a Medicated Seton): A Case Report

Case ReportA 10-year-old boy had been suffering from recurrent perianal abscesses since August 2018.He had a history of abscess drainage multiple times.A physical examination was conducted in July 2019 at Om Ayurvedic Clinic.On examination in the lithotomy position, the internal opening was at the 12 o'clock position, 1 cm from the anal verge.There was no anal sphincter spasm.Specific non-diagnostic conditions were excluded.Magnetic resonance imaging revealed a linear fistula 3.7 cm in length with an internal opening at the 12 o'clock position (Figure 1).A blind extension toward the scrotum was 1.5 cm from the external opening.The patient was healthy and there ABSTRACT Fistula in ano (FIA) in the pediatric population is infrequent and poorly understood.The management of paediatric FIA remains a matter of debate.This case report highlights a 10-year-old boy with an inter-sphincteric fistula successfully treated with Kshar Sutra (a medicated herbal seton), with weekly thread changes.The procedure was conducted under local anaesthesia.Antibiotics were not given to prevent infection.The wound was completely healed in 7 weeks.The child has been fistula-free for 5 years, indicating that the Kshar Sutra method is an effective treatment option for similar pediatric cases.