Fistula in ano is an abnormal hollow inflammatory tract or cavity that is lined with unhealthy granulation tissue. Sushruta described satponaka bhagandara as paka pidikann (ripened blister), daruna ruja (severe pain), bhinna aruna phena vahini(when the blister open it presents reddish yellow with frothy discharges), aneka vrana(many openings) etc. This study aims at diagnosing a case of satponaka bhagandara and treating it with integrated approach and assessing the result using TRUS (Transrectal ultrasonography). A 47 year old male patient visited in out patient department of Shalya tantra having complaints of 6 to 7 boils at his perianal region, since two year and pus discharge for last 6 months. On examination, the case was diagnosed as satponaka bhagandara (anterior horseshoe fistula with multiple openings). All external fistulous tracks were partially excised and ksharsootra was inserted in rest of the track. Post operative dressing was done using apamarga kshar pichu and humari oil. Post operative wound was assessed weekly. On second week assessment, slough had decreased, serous discharge was present, there was no induration and wound size was approximatly 38.7cm2. Wound healed by 9 week completely, follow-up was taken after one month and then after one year healthy scar was seen, sphincter tone was within normal limit and there was no evidence of fistula. This case study revealed that anterior horse shoe
fistula-in-ano with multiple openings can be managed by partial fistulectomy and Apamarga based ksharsootra along with the adjuvent drugs like humari oil and apmarga kshar.
Key words: Apamarga, Humari, Kshar, Ksharsootra, Transrectal ultrasonography (TRUS)
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