Chhedana (Excision) and Adjuvant Ayurvedic Remedies in the Management of Anal Warts (Condyloma Acuminata): A Single Case Report

Abstract

Anal warts are the commonest benign, viral condition found in day to day practice in ano-rectal surgeries. Anogenital warts (Condyloma acuminata) caused by Human Papilloma Virus (HPV) infection and associated with squamous intra-epithelium lesions and squamous cell carcinoma. It occurs in the perianal area or in the squamous epithelium of distal anal canal. Many methods of treating condyloma acuminata have been employed such as topical application of podophyllin ointment which has many disadvantages like skin burns, requires multiple visits and systemic toxicity. As per Acharya Sushruta, Agnikarma has been described as one of the superior para-surgical procedure as the diseases treated by it, usually have no recurrence. In this present case report 47 years old male patient visited in OPD of Shalya Tantra having complaints of growth at perianal region with occasionally itching since last 8-9 years. Growth is gradually increasing in size and causing discomfort, pain and burning in ano during defaecation since last 6-7 months. Clinical appearance of the lesion makes the diagnosis obvious but the histopathological report reveals Condyloma acuminata. So, Chhedana (Surgical Excision) with cautery was planned after patient got negative report for HPV DNA test. Growth lesion was completely excised under spinal anaesthesia. Clinically it mimics with carcinoma so repeat histopathologic examination was done after complete excision which showed invasive squamous cell carcinoma in situ. So, the patient was referred to higher centre to oncologist for further evaluation and management. After thorough examination by oncologist it excluded the possibility of malignancy by haematological investigations and CT scan of thorax, abdomen and pelvis, which were found normal. This case was managed post operatively with 2 tablets (500 mg each) Triphala Guggulu thrice in a day after meal for 1.5 months and daily sitz bath with Panchavalkala Kwatha and dressing with Jatyadi taila was performed till complete healing of post operative wound. Within 4 weeks wound was healed completely and no complaints of any recurrence or stenosis or stricture was found. This case demonstrates that condyloma acuminata can be managed through Ayurveda without any complications and is cost-effective.