Interception of Fistulous Tract and Application of Ksharasutra (IFTAK) in a Grade IV Trans-sphincteric Fistula in Ano with Scrotal Extension: A Case Report
Abstract: Background: Complex trans-sphincteric fistula in ano presents a treatment challenge when definitive management must be balanced against the risk of sphincter injury. IFTAK (Interception of Fistulous Tract and Application of Ksharasutra) is a modified Ksharasutra-based technique involving operative interception of the fistulous tract followed by Ksharasutra application. Case presentation: A 31-year-old man presented with a 6-month history of constipation, bleeding per rectum, pain on straining, burning, itching, pricking pain, and purulent discharge from a scrotal external opening. MRI fistulography demonstrated a Grade IV trans-sphincteric fistula with an approximately 8.8 cm primary tract extending from the root of the scrotal sac to the anal canal, a small blind-ending secondary ramification, and no abscess. The patient underwent IFTAK under spinal anesthesia. The tract was identified and curetted, inter-sphincteric access was obtained, and a 30-number Ksharasutra was placed without deliberate division of the external sphincter. Serial Ksharasutra changes and adjunctive wound and medical therapies were continued. Outcome: Ksharasutra clearance was documented on 27 February 2026. At follow-up on 16 March 2026 the wound was dry without pain or purulent discharge. At final assessment on 26 June 2026, approximately four months after Ksharasutra clearance, there was clinical healing without clinical evidence of recurrence. No flatus or fecal incontinence was reported. Conclusion: This case demonstrates the feasibility of IFTAK with Ksharasutra in an anatomically extensive trans-sphincteric fistula with scrotal extension. The outcome represents the complete multimodal treatment protocol, and the contribution of IFTAK alone cannot be determined from a single case.
Keywords: Fistula in ano; Bhagandara; Ksharasutra; IFTAK; Trans-sphincteric fistula; Scrotal extension; Ayurveda
How to Cite?: Dr. Kunal Kamthe, "Interception of Fistulous Tract and Application of Ksharasutra (IFTAK) in a Grade IV Trans-sphincteric Fistula in Ano with Scrotal Extension: A Case Report", Volume 15 Issue 10, October 2026, International Journal of Science and Research (IJSR), Pages: 219-223, https://www.ijsr.net/getabstract.php?paperid=SR261002170130, DOI: https://dx.doi.org/10.21275/SR261002170130