Vol. 3, Issue 1, Part B (2026)

Introduction: Osteomyelitis is an infectious disease of bone which is a difficult disease to treat. In advanced stages, the infection spreads to the surrounding tissues which may result in formation of a fistulous track which can present as a continuous discharge through its external (cutaneous) opening. Fistula-in-ano is treated by various surgical procedures including fistulotomy, fistulectomy, LIFT, Setons, fibrin glue, laser etc. In Ayurveda, however Ksharasutra (caustic alkaline thread) is regarded as the best line of treatment in any kind of sinus infection and the same treatment has been extended to Fistula-in-ano in past century with a lot of modification which has become a pioneer in itself finding a mention in modern surgical text books as well. In the present case study after controlling osteomyelitis with antibiotics and Nano-extracts of Curcumin, we have carried out a blended procedure using partial fistulectomy and then placement of Ksharasutra for fistula-in-ano.

Clinical Findings and Presenting Symptoms: A 40 yr. old male patient diagnosed with Fistula-in-ano with underlying osteomyelitis of coccyx visited our OPD section and after proper evaluation it was found that the patient has previously been operated for fistula-in-ano by fistulotomy which was unsuccessful in mitigating the disease and has resulted in partial loss of anal tone as well because of damage to internal anal sphincter musculature during the surgical procedure. The presenting symptoms were active puss discharge with collected in perianal area as an abscess. No fever, malaise, pain was noticed. Low anal tone due to previous surgery was noticed on per rectal examination.

Main Diagnosis and Therapeutic Intervention: The patient was diagnosed with osteomyelitis of coccyx bone which presented as perianal fistula based on the contrast MRI. The challenge was to design a procedure which can mitigate three components simultaneously: cure the osteomyelitis, disinfect and heal the fistulous track and prevent any damage to internal sphincter which may result in post-operative incontinence. Hence it was decided to give antibiotics (Faropenem 300 mg) twice daily and Nano- extracts of Curcuma Longa (Haldi) 30 mg twice daily as first line of treatment followed by a Trans Rectal Ultrasonography (TRUS) to establish elimination of infection to coccyx bone. On confirmation of infection free bone a surgical procedure under spinal anesthesia was carried out with partial fistulectomy, de-roofing and drainage of the abscess which had formed near the external opening followed by placement of Ksharasutra (Standard 21 layer- Snuhii Latex (10), Apamarga Kshara (7), Haridra Powder (4)) in the main fistulous track using a copper malleable probe. After proper hemostasis, the external wound was packed by a sterile gauze dipped in Septiloc antiseptic lotion (Venus Ayurveda). Patient was kept under observation for post-operative care. On discharge oral antibiotics in form of Faropenem 300 mg twice daily and Nano- extracts of Curcuma Longa (Haldi) 30 mg twice daily were given for next one week again. Ksharasutra was changed every 7^th day for next 7 weeks with no to minimal cutting followed by dressing with Septiloc lotion regularly. Ksharsutra was removed in 7^th week when there was no discharge from the fistulous track and the external wound had healed completely.