title: Anal fistula with foot extension-Treated by kshara sutra (medicated seton) therapy: A rare case report.
abstract: BACKGROUND
  An 'anal' fistula is a track which communicates anal canal or rectum and usually is in continuity with one or more external openings. Distant communication from rectum is rare. It is a challenging disease because of its recurrence especially, with high level and distant communications. Ksharasutra (medicated seton) therapy is being practiced in India with high success rate (recurrence of 3.33%) in the management of complicated anal fistula.
  
  
  METHODS
  A 56 year old man presented with recurrent boils in the left lower limb at different places from thigh to foot. He underwent repeated incision and drainage at different hospitals. Examination revealed sinus with discharge and multiple scars on left lower limb from thigh up to foot. Suspecting anal fistula, MRI was advised which revealed a long cutaneous fistula from rectum to left lower limb. Patient was treated with Ksharasutra therapy. Within 6 months of treatment whole tract was healed completely.
  
  
  CONCLUSIONS
  Sushrutha (500BC) was the first to explain the role of surgical excision and use of kshara sutra for the management of anal fistula. Ksharasutra therapy showed least recurrence. Fistula from rectum to foot is of extremely rare variety. Surgical treatment of anal fistula requires hospitalization, regular post-operative care, is associated with a significant risk of recurrence (0.7-26.5%) and a high risk of impaired continence (5-40%).
  
  
  CONCLUSIONS
  Rectal fistula communicating till foot may be a very rare presentation in proctology practice. Kshara sutra treatment was useful in treating this condition, with minimal surgical intervention with no recurrence.
authors.affiliation: Department of Shalyatantra (Surgery in Ayurveda, Indian Medicine), Sri Sri College of Ayurvedic Science and Research Hospital (Affiliated to Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore), 21st KM, Kanakapura Road, Bangalore 560082, India. Electronic address: prameshbhat@yahoo.co.in.
authors.forename: P Bhat
authors.initials: PB
authors.lastname: Ramesh