Unusual occurrence of stony hard material in posterior anal fistula (bhagandara)

The occurrence of stony material in the anal fistulous tract is a very rare clinical presentation; till today there are only three evident citation in pubmed indexed journals. Anal fistula (bhagandhara) is a chronic inflammatory tubular structure connecting the anorectal canal with peri-anal skin. A 66-year-old male patient presented with complaints of persistent pain in the perianal region and soiling of the undergarments with stool and constipation since 2 years. The case was diagnosed as posterior low anal fistula by per rectal digital, proctoscopic, and by fistulogram. It can be correlated to agantuja/unmargi bhagandhara. In the present case, "stasis" and "infection" might the reasons for the formation of stony hard material. Patient was successfully treated by the excision of whole tract with the unusual stone under local anesthesia. The presence of stony hard material in the fistulous tract is a very rare presentation and was successfully managed.