Two stage operative management of horseshoe fistula in ano – A case report

Horseshoe fistula in ano presents unique clinical challenges due to its involvement with the sphincter muscle and its intricate configuration. This condition may result in anal sphincter incontinence and higher recurrence rates, making operational care particularly demanding. This case report highlights the successful management of a complex horseshoe fistula, emphasizing the operative strategy to preserve continence while achieving complete healing. Patient’s Main Concerns and Clinical Findings: The patient, a 30-year- old male, presented to the Shalyatantra OPD with complaints of recurrent perianal boils, pain, and pus discharge for one and a half months. Perianal examination revealed multiple external openings bilaterally, and digital rectal examination indicated an internal opening at the 6 o’clock position. Trans-rectal ultrasonography (TRUS) confirmed a horseshoe fistula with a 15–16 cm long branching tract and external openings at 8, 4, and 2 o'clock positions, with the internal opening located 10 mm proximal to the anal verge between 6 and 7 o’clock positions. The case was classified as grade II according to the Pankaj Garg classification.