Multiple bilateral costo-chondral abscesses due to Mycobacterium tuberculosis

Multiple abscesses of the costo-chondral junctions are very uncommon in practice.In this report we present the case of a 55 year old man who presented to us with chest pain and fever of few months duration.On imaging with ultrasound and CECT we were able to demonstrate multiple abscesses of costo-chondral junctions bilaterally.We confirmed tuberculosis by FNAC and BACTEC cultures from abscesses.

Liver Abscesses in General Surgery at CsRef CI in Bamako Mali

Liver abscesses correspond to a newly formed cavity created by necrosis of the liver parenchyma induced by the pathogen. The aim of the present work was to study liver abscesses;determine the frequency;describe the clinical and paraclinical aspects, therapeutic and evolutionary modalities;determine the follow-up of treatment in order to assess the cost of treatment in the Reference Health Center of Commune I of Bamako in Mali. This prospective study, involving 30 cases of liver abscess, took place over a period of 24 months from January 2015 to December 2016 in the general surgery department of the Cs Ref of commune I. The liver abscess is very often the consequence of amoebiasis which is rampant in the underprivileged population and it remains topical in surgical practice in Mali. Our hospital frequency was 0.081% with an average age of 34.40 years and extremes of 16 and 61 years;a sex ratio of 2.3 in favor of men. The main clinical signs were fever (56.7%), hepatalgia (73.3%) and hepatomegaly (26.7%). Hepatic collections objectified on abdominal ultrasound were located in the right lobe in 70% of cases and unique in 62%. Amebic serology carried out in 100% was negative in 20%;10% of cases had undergone surgical treatment. The consequences were simple for all our patients. The average cost of care, approximately 100,000 FCFA, was significantly higher than the minimum wage (28,460 FCFA) in Mali.

Mortal condition in an unusual localization,analysis of isolated tongue and tongue base abscesses

BACKGROUND Tongue abscess(TA)is a very rare clinical condition and its treatment is very important.Surgical drainage is at the forefront in the treatment.Our study includes patients with tongue and tongue base abscesses.AIM To discuss the clinical and laboratory findings of these patients emphasizing the underlying causes and treatment options with the largest patient series in the English literature.METHODS We included patients with isolated TA who applied to our clinic between January 1,2020 and January 1,2023.Those who lack the recorded data,those who are not between the ages of 18-66,those who have not undergone surgery-interventional procedure,and those who have infection and/or abscess in another place were excluded from the study.RESULTS There were two female(18%)and nine male(82%)patients in our series consisting of 11 patients.Their ages ranged from 18 to 66,and the mean±SD was 48.63±16.3.Considering the localization of the abscess,three anterior abscesses(27%),two lateral abscesses(18%),and six abscesses at the base of the tongue(54%)were detected.CONCLUSION Tongue abscesses can cause acute upper airway obstruction and respiratory collapse.It may be necessary to act quickly for the tracheotomy procedure and this procedure can usually be performed under local anesthesia as intubation cannot be achieved.When we encounter an abscess in an unexpected organ,difficulties may be encountered in the management of the patient.

Blood purification for treatment of non-liquefied multiple liver abscesses and improvement of T-cell function:A case report

BACKGROUND Non-liquefied multiple liver abscesses(NMLA)can induce sepsis,septic shock,sepsis-associated kidney injury(SA-AKI),and multiple organ failure.The inability to perform ultrasound-guided puncture and drainage to eradicate the primary disease may allow for the persistence of bacterial endotoxins and endogenous cytokines,exacerbating organ damage,and potentially causing immunosuppression and T-cell exhaustion.Therefore,the search for additional effective treatments that complement antibiotic therapy is of great importance.CASE SUMMARY A 45-year-old critically ill female patient presented to our hospital’s intensive care unit with intermittent vomiting,diarrhea,and decreased urine output.The patient exhibited a temperature of 37.8℃.Based on the results of liver ultrasonography,laboratory tests,fever,and oliguria,the patient was diagnosed with NMLA,sepsis,SA-AKI,and immunosuppression.We administered antibiotic therapy,entire care,continuous renal replacement therapy(CRRT)with an M100 hemofilter,and hemoperfusion(HP)with an HA380 hemofilter.The aforementioned treatment resulted in a substantial reduction in disease severity scores and a decrease in the extent of infection and inflammatory factors.In addition,the treatment stimulated the expansion of the cluster of differentiation 8^(+)(CD8^(+))Tcells and led to the complete recovery of renal function.The patient was discharged from the hospital.During the follow-up period of 28 d,she recovered successfully.CONCLUSION Based on the entire therapeutic regimen,the early combination of CRRT and HP therapy may control sepsis caused by NMLA and help control infections,reduce inflammatory responses,and improve CD8^(+)T-cell immune function.

Molecular mechanism of Xuebijing in treating pyogenic liver abscess complicated with sepsis

BACKGROUND:Xuebijing(XBJ)can alleviate the inflammatory response,improve organ function,and shorten the intensive care unit(ICU)stay in patients with pyogenic liver abscess(PLA)complicated with sepsis,but the molecular mechanisms have not been elucidated.This study aimed to explore the molecular mechanism of XBJ in treating PLA complicated with sepsis using a network pharmacology approach.METHODS:The active ingredients and targets of XBJ were retrieved from the ETCM database.Potential targets related to PLA and sepsis were retrieved from the GeneCards,PharmGKB,DisGeNet,Online Mendelian Inheritance in Man(OMIM),Therapeutic Targets Database(TTD),and DrugBank databases.The targets of PLA complicated with sepsis were mapped to the targets of XBJ to identify potential treatment targets.Protein-protein interaction networks were analyzed using the STRING database.Potential treatment targets were imported into the Metascape platform for Gene Ontology(GO)functional enrichment and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analyses.Molecular docking was performed to validate the interactions between active ingredients and core targets.RESULTS:XBJ was found to have 54 potential treatment targets for PLA complicated with sepsis.Interleukin-1β(IL-1β),interleukin-6(IL-6),and tumor necrosis factor(TNF)were identifi ed as core targets.KEGG enrichment analysis revealed important pathways,including the interleukin-17(IL-17)signaling pathway,the TNF signaling pathway,the nuclear factor-kappa B(NF-κB)signaling pathway,and the Toll-like receptor(TLR)signaling pathway.Molecular docking experiments indicated stable binding between XBJ active ingredients and core targets.CONCLUSION:XBJ may exert therapeutic eff ects on PLA complicated with sepsis by modulating signaling pathways,such as the IL-17,TNF,NF-κB,and TLR pathways,and targeting IL-1β,IL-6,and TNF.

Post-Traumatic Palatine Odontogenic Abscess: About 2 Cases

Introduction: Palatal abscess or cellulitis of dental origin is a rare clinical form of circumscribed cellulitis that can sometimes pose a diagnostic problem. It is the consequence of poor or non-treatment of dental caries or trauma. The aim of this study is to describe the clinical and therapeutic aspects of these two cases of palatal cellulitis of post-traumatic dental origin. Observation: The patients consulted for painful palatal swelling secondary to untreated dental trauma of the 21s. The diagnosis of palatal cellulitis was based on the inflammatory and fluctuating nature of the swelling. A probabilistic bi-antibiotic treatment and an incision and drainage associated with treatment of the portal of entry were carried out. Progression was favourable in both cases. Conclusion: Palatal cellulitis is a rare condition and can be prevented by systematic stomatological consultation after dental trauma. Diagnosis is clinical. However, CT scans are sometimes useful. The course is generally favorable with appropriate treatment.

Amebic liver abscess: An update

Amebic liver abscess(ALA)is still a common problem in the tropical world,where it affects over three-quarters of patients with liver abscess.It is caused by an anaerobic protozoan Entamoeba hystolytica,which primarily colonises the cecum.It is a non-suppurative infection of the liver consisting primarily of dead hepatocytes and cellular debris.People of the male gender,during their reproductive years,are most prone to ALA,and this appears to be due to a poorly mounted immune response linked to serum testosterone levels.ALA is more common in the right lobe of the liver,is strongly associated with alcohol consumption,and can heal without the need for drainage.While majority of ALA patients have an uncomplicated course,a number of complications have been described,including rupture into abdomino-thoracic structures,biliary fistula,vascular thrombosis,bilio-vascular compression,and secondary bacterial infection.Based on clinico-radiological findings,a classification system for ALA has emerged recently,which can assist clinicians in making treatment decisions.Recent research has revealed the role of venous thrombosis-related ischemia in the severity of ALA.Recent years have seen the development and refinement of newer molecular diagnostic techniques that can greatly aid in overcoming the diagnostic challenge in endemic area where serology-based tests have limited accuracy.Metronidazole has been the drug of choice for ALA patients for many years.However,concerns over the resistance and adverse effects necessitate the creation of new,safe,and potent antiamebic medications.Although the indication of the drainage of uncomplicated ALA has become more clear,high-quality randomised trials are still necessary for robust conclusions.Percutaneous drainage appears to be a viable option for patients with ruptured ALA and diffuse peritonitis,for whom surgery represents a significant risk of mortality.With regard to all of the aforementioned issues,this article intends to present an updated review of ALA.

Brain abscess caused by Streptococcus anginosus group:Three case reports

BACKGROUND This case series investigated the clinical manifestations,diagnoses,and treatment of cerebral abscesses caused by Streptococcus anginosus.We retrospectively analyzed the clinical characteristics and outcomes of three cases of cerebral abscesses caused by Streptococcus anginosus and conducted a comprehensive review of relevant literature.CASE SUMMARY Case 1 presented with a history of left otitis media and exhibited high fever,confusion,and vomiting as primary symptoms.Postoperative pus culture indicated a brain abscess caused by Streptococcus constellatus infection.Case 2 experienced dizziness for two days as the primary symptom.Postoperative pus culture suggested an intermediate streptococcal brain abscess.Case 3:Enhanced head magnetic resonance imaging(MRI)and diffusion-weighted imaging revealed occupancy of the left temporal lobe,initially suspected to be a metastatic tumor.However,a postoperative pus culture confirmed the presence of a brain abscess caused by Streptococcus anginosus infection.The three cases presented in this case series were all patients with community-acquired brain abscesses resulting from angina caused by Streptococcus group infection.All three patients demonstrated sensitivity to penicillin,ceftriaxone,vancomycin,linezolid,chloramphenicol,and levofloxacin.Successful treatment was achieved through stereotaxic puncture,drainage,and ceftriaxone administration with a six-week course of antibiotics.CONCLUSION Preoperative enhanced head MRI plays a critical role in distinguishing brain tumors from abscesses.Selecting the correct early diagnostic methods for brain abscesses and providing timely intervention are very important.This case series was in accordance with the CARE guidelines.

Special stent for draining the abdominal abscess respectively from colon and duodenum:A case report

BACKGROUND Postoperative abdominal infections are an important and heterogeneous health challenge.Many samll abdominal abscesses are resolved with antibiotics,but larger or symptomatic abscesses may require procedural management.CASE SUMMARY A 65-year-old male patient who suffered operation for the left hepatocellular carcinoma eight months ago,came to our hospital with recurrent abdominal pain,vomit,and fever for one month.Abdominal computed tomography showed that a big low-density dumbbell-shaped mass among the liver and intestine.Colonoscopy showed a submucosal mass with a fistula at colon of liver region.Gastroscopy showed a big rupture on the submucosal mass at the descending duodenum and a fistula at the duodenal bulb.Under colonoscopy,the brown liquid and pus were drained from the mass with“special stent device”.Under gastroscopy,we closed the rupture of the mass with a loop and six clips for purse stitching at the descending duodenum,and the same method as colonoscopy was used to drain the brown liquid and pus from the mass.The symptom of abdominal pain,vomit and fever were relieved after the treatment.CONCLUSION The special stent device could be effectively for draining the abdominal abscess respectively from colon and duodenum.

Coexistence of liver abscess, hepatic cystic echinococcosis and hepatocellular carcinoma: A case report

BACKGROUND Human cystic echinococcosis(CE)is a life-threatening zoonosis caused by the Echinococcus granulosus(sensu lato).Hepatocellular carcinoma(HCC)is a leading cause of cancer-related mortality in the world.The coexistence of CE and HCC is exceedingly rare,and only several well-documented cases have been reported.In addition to this coexistence,there is no report of the coexistence of CE,HCC,and liver abscess to date.Herein,we aimed to report a case of coexistence of liver abscess,hepatic CE,and HCC.CASE SUMMARY A 65-year-old herdsman presented to the department of interventional therapy with jaundice,right upper abdominal distension and pain for 10 d.Laboratory test showed that he had positive results for HBsAg,HBeAb,HBcAb,and echino-coccosis IgG antibody.The test also showed an increased level of alpha fetopro-tein of 3400 ng/mL.An abdominal computed tomography(CT)scan revealed an uneven enhanced lesion of the liver at the arterial phase with enhancement and was located S4/8 segment of the liver.In addition,CT scan also revealed a mass in the S6 segment of the liver with a thick calcified wall and according to current guideline and medical images,the diagnoses of hepatic CE(CE4 subtype)and HCC were established.Initially,transarterial chemoembolization was performed for HCC.In the follow-up,liver abscess occurred in addition to CE and HCC;thus,percutaneous liver puncture drainage was performed.In the next follow-up,CE and HCC were stable.The liver abscess was completely resolved,and the patient was discharged with no evidence of recurrence.CONCLUSION This is the first reported case on the coexistence of liver abscess,hepatic CE,and HCC.Individualized treatment and multidisciplinary discussions should be performed in this setting.Therefore,treatment and diagnosis should be based on the characteristics of liver abscess,hepatic CE,and HCC,and in future clinical work,it is necessary to be aware of the possibility of this complex composition of liver diseases.

Paragonimiasis misdiagnosed as liver abscess:A case report

BACKGROUNDParagonimiasis is a typical food-borne zoonotic disease. Hosts acquire Paragonimusinfection through the ingestion of raw or undercooked crayfish and crab.The clinical manifestations of the disease are varied, and it is often misdiagnosedor missed. The diagnosis of paragonimiasis should be considered comprehensively.Praziquantel is the first choice for treatment, and albendazole can beused in combination with repeated courses in severe cases.CASE SUMMARYWe report a case of liver paragonimiasis that was misdiagnosed as an abscess. Thepatient presented with fatigue and poor appetite for 2 months, and was diagnosedwith liver abscess in the local hospital. After 6 months, the patient visited ourhospital because of recurrent abdominal pain and was diagnosed with liverparagonimiasis based on epidemiological history, clinical presentations, andlaboratory findings. He was treated with praziquantel (25 mg/kg) three times aday for 3 days;however, the symptoms still presented after treatment. He wastreated with oral praziquantel and albendazole for one further course. Follow-upsuggested that the treatment was effective and the symptoms improved.CONCLUSIONThe combination of albendazole and praziquantel may improve the therapeuticefficacy of paragonimiasis.

Cerebral syphilitic gumma misdiagnosed as brain abscess: A case report

BACKGROUND Cerebral syphilitic gumma is a relatively rare clinical disease.Its clinical manifest-ations are non-specific,and the imaging manifestations are similar to other in-tracranial occupying lesions,often misdiagnosed as tumors or abscesses.There are few reports on this disease in the relevant literature.To our knowledge,we have reported the first case of cerebral syphilitic gumma misdiagnosed as a brain abscess.We report this case and provide useful information for clinical doctors on neurosyphilis diseases.CASE SUMMARY We report the case to explore the diagnostic essentials of cerebral syphilitic gumma and attempt to mitigate the rates of misdiagnosis and missed diagnosis by equipping physicians with knowledge of neurosyphilis characteristics.The cli-nical diagnosis and treatment of a patient with cerebral syphilitic gumma were reported.Clinical manifestations,classifications,and diagnostic points were retro-spectively analyzed.The patient was admitted to the hospital with fever and limb weakness.Brain magnetic resonance imaging showed multiple space-occupying lesions and a positive serum Treponema pallidum gelatin agglutination test.The patient was misdiagnosed as having a brain abscess and underwent a craniotomy.A postoperative pathological diagnosis of syphilis gumma was made.The patient improved and was discharged after penicillin anti-syphilis treatment.Follow-up recovery was satisfactory.CONCLUSION Cerebral syphilitic gumma is rare in clinical practice,and it is often misdiagnosed and missed.Clinical diagnosis should be considered in combination with multiple examinations.

Tuberculous peritonitis complicated by an intraperitoneal tuberculous abscess: A case report

BACKGROUND Tuberculous peritonitis(TBP)is a chronic,diffuse inflammation of the peritoneum caused by Mycobacterium tuberculosis.The route of infection can be by direct spread of intraperitoneal tuberculosis(TB)or by hematogenous dissemination.The former is more common,such as intestinal TB,mesenteric lymphatic TB,fa-llopian tube TB,etc.,and can be the direct primary lesion of the disease.CASE SUMMARY We present an older male patient with TBP complicated by an abdominal mass.The patient's preoperative symptoms,signs and imaging data suggested a poss-ible abdominal tumor.After surgical treatment,the patient's primary diagnosis of TBP complicating an intraperitoneal tuberculous abscess was established by com-bining past medical history,postoperative pathology,and positive results of TB-related laboratory tests.The patient's symptoms were significantly reduced after surgical treatment,and he was discharged from the hospital with instructions to continue treatment at a TB specialist hospital and to undergo anti-TB treatment if necessary.CONCLUSION This case report analyses the management of TBP complicated by intraperitoneal tuberculous abscess and highlights the importance of early definitive diagnosis in the hope of improving the clinical management of this type of disease.

Ipsilateral retroperitoneal papillary renal cell carcinoma 27 years after simple nephrectomy for a renal abscess:A case report

BACKGROUND Cases of severe inflammatory renal disease and renal cell carcinoma(RCC)that occur simultaneously in the same kidney have been occasionally reported.However,extrarenal RCC that does not originate from the native kidney has rarely been reported.To our knowledge,this is the first reported case of RCC developing in the ipsilateral retroperitoneal space after a simple nephrectomy(SN)for inflammatory renal disease.CASE SUMMARY A 63-year-old woman was referred to our hospital following the incidental discovery of a left retroperitoneal mass without specific symptoms.Her medical history revealed a left SN 27 years ago due to a renal abscess.Magnetic resonance imaging of the abdomen revealed three oval masses in the left retroperitoneum.The masses were successfully excised,and subsequent pathology confirmed papillary RCC.After surgery,the patient remained disease-free for 11 years without adjuvant therapy.CONCLUSION Clinicians should be vigilant of RCC in patients with retroperitoneal masses,especially after SN for inflammatory renal disease.

Primary hepatic lymphoma presenting as pyogenic liver abscess:A case report

BACKGROUND Primary hepatic lymphoma(PHL)is a lymphoproliferative disorder confined to the liver without peripheral lymph node involvement and bone marrow invasion.PHL is extremely rare in clinical practice.The etiology and pathogenesis of PHL are largely unknown.There are no common standard protocols or guidelines for the treatment of PHL.CASE SUMMARY We report the case of a 66-year-old man who presented with fever and abdominal pain for three weeks.Computed tomography and magnetic resonance imaging scans showed a pyogenic liver abscess.The patient underwent a right posterior hepatectomy.The surgical pathology revealed aggressive B-cell lymphoma,with a primary consideration of diffuse large B-cell lymphoma of non-germinal center origin.CONCLUSION This article reviews the characteristics,mechanism and treatment of PHL and provides insight into the diagnosis of PHL.

Endoscopic retrograde appendicitis treatment for periappendiceal abscess: A case report

BACKGROUND Acute appendicitis is the most common abdominal emergency.At present,the main treatments for periappendiceal abscess include antibiotics and surgery.However,the complications and mortality of emergency surgery are high.The preferred therapy is conservative treatment with antibiotics first,ultrasound-guided puncture drainage or surgical treatment is followed when necessary.Endoscopic retrograde appendicitis therapy(ERAT)for acute uncomplicated appendicitis have been proved clinically effective,but it is rarely used in periap-pendiceal abscess.CASE SUMMARY We report a patient admitted to hospital because of“right lower abdominal pain for six days”.The computerized tomography(CT)of patient showed that appendicitis with fecaliths and abscess in the pelvis.The patient was treated by CT-guided puncture and drainage of abdominal abscess combined with ERAT to remove appendiceal fecaliths,irrigation and stent placement.CONCLUSION The patient did not receive surgery because of impoverished family.Abdominal pain did not recur during the follow-up period.This case confirms the value of ERAT in the treatment of periappendiceal abscess.

Brain abscess from oral microbiota approached by metagenomic next-generation sequencing: A case report and review of literature

BACKGROUND Brain abscess is a serious and potentially fatal disease caused primarily by microbial infection.Although progress has been made in the diagnosis and treatment of brain abscesses,the diagnostic timeliness of pathogens needs to be improved.CASE SUMMARY We report the case of a 54-year-old male with a brain abscess caused by oral bacteria.The patient recovered well after receiving a combination of metagenomic next-generation sequencing(mNGS)-assisted guided medication and surgery.CONCLUSION Therefore,mNGS may be widely applied to identify the pathogenic microor-ganisms of brain abscesses and guide precision medicine.

Liver abscess and tracheal fistula induced by transcatheter arterial chemoembolization for hepatocellular carcinoma:A case report

BACKGROUND Transarterial chemoembolization(TACE)is a standard treatment for intermediate-stage hepatocellular carcinoma(HCC).The complications of TACE include biliary tract infection,liver dysfunction,tumor lysis syndrome,biloma,partial intestinal obstruction,cerebral lipiodol embolism,etc.There are few reports about tracheal fistula induced by TACE.CASE SUMMARY A 42-year-old man came to our hospital with cough and expectoration for 1 month after TACE for HCC.Laboratory test results showed abnormalities of albumin,hemoglobin,prothrombin time,C-reactive protein,D-dimer,and prothrombin.Culture of both phlegm and liver pus revealed growth of Citrobacter flavescens.Computed tomography showed infection in the inferior lobe of the right lung and a low-density lesion with gas in the right liver.Liver ultrasound showed that there was a big hypoechoic liquid lesion without blood flow signal.Drainage for liver abscess by needle puncture under ultrasonic guidance was performed.After 1 month of drainage and anti-infection therapy,the abscess in the liver and the infection in the lung were reduced obviously,and the symptom of expectoration was relieved.CONCLUSION Clinicians should be alert to the possibility of complications of liver abscess and tracheal fistula after TACE for HCC.Drainage for liver abscess by needle puncture under ultrasonic guidance could relieve the liver abscess and tracheal fistula.

Coinfection with hepatic cystic and alveolar echinococcosis with abdominal wall abscess and sinus tract formation:A case report

BACKGROUND Hepatic cystic and alveolar echinococcosis coinfections,particularly with concurrent abscesses and sinus tract formation,are extremely rare.This article presents a case of a patient diagnosed with this unique presentation,discussing the typical imaging manifestations of both echinococcosis types and detailing the diagnosis and surgical treatment experience thereof.CASE SUMMARY A 39-year-old Tibetan woman presented with concurrent hepatic cystic and alveolar echinococcosis,accompanied by abdominal wall abscesses and sinus tract formation.Initial conventional imaging examinations suggested only hepatic cystic echinococcosis,but intraoperative and postoperative pathological examination revealed the coinfection.Following radical resection of the lesions,the patient’s condition improved,and she was discharged soon thereafter.Subsequent outpatient follow-ups confirmed no recurrence of the hydatid lesion and normal surgical wound healing.Though mixed hepatic cystic and alveolar echinococcosis with abdominal wall abscesses and sinus tract formations are rare,the general treatment approach remains consistent with that of simpler infections of alveolar echinococcosis.CONCLUSION Lesions involving the abdominal wall and sinus tract formation,may require radical resection.Long-term prognosis includes albendazole and follow-up examinations.

A case study illustrating the use of an integrated approach to treat secondary Anal Fistula Post I&D of Perianal Abscess

Background:Anal fistula is a long-term disease characterized by a tubular structure with one end opening in the anorectal canal and the other end opening on the surface of the perineum or perianal skin with chronic pus drainage.It is linked to Bhagandar in Ayurveda,and in Sushruta Samhita,Acharya has mentioned 5 forms of Bhagandar.The boil in the present case was Shukla,sthira i.e.hard and firm,with Picchila strava and Kandu resembling the features of Parisraavi bhagandar.Aim and objective:The current case was diagnosed as Parisravi bhagandar,which resembles trans-sphincteric or intersphincteric fistula in modern ano.In Ayurveda,the management of Parisraavi Bhagandar,Shastra,kshara,and Agnikarma is advised and the use of Ksharasutra,which contributes to complete cutting and healing of the track without reoccurrence,similarly Modern surgeon depends on surgery i.e radical excision of the track,ligation with Seton,and use of chemical irritants like urethane,silver nitrates,etc.A cutting seton(tight)gently slices the confined muscle to close the fistula with the least interruption to continence.This operation is especially advised when a one-stage fistulotomy poses a considerable risk of incontinence.Material and methods:The method performed here was Core Partial Fistulectomy followed by Ksharasutra application till complete healing of the wound.Discussion and conclusion:This case study provides the successful management of Parisraavi Bhagandara(high anal,trans-sphincteric fistula in ano)in 61-year-old male patient with an integrated surgical&Ayurvedic management approach.