A Single case study of Pilonidal Sinus managed through Ayurvedic Surgical Treatment Vis-à-vis through Chedhana Karma (Wide Excision)

D Meghana; Siddayya Aradhyamath; J.V. Adithya; Shivakumar Aladakatti; I T Mallinath

A Single case study of Pilonidal Sinus managed through Ayurvedic Surgical Treatment Vis-à-vis through Chedhana Karma (Wide Excision)

Meghana D.^1*, Aradhyamath S.², Adithya J.³, Aladakatti S.⁴, Mallinath I.⁵

DOI:

^1* D Meghana, First Year Post Graduate Scholar, Department of PG and PhD Studies in Shalya Tantra, JSS Ayurveda Medical College, Mysuru, Karnataka, India.

² Siddayya Aradhyamath, Professor and HOD, Department of PG and PhD Studies in Shalya Tantra, JSS Ayurveda Medical College, Mysuru, Karnataka, India.

³ J.V. Adithya, Assistant Professor, Dept of PG and PhD Studies in Shalya Tantra, JSS Ayurveda Medical College, Mysuru, Karnataka, India.

⁴ Shivakumar Aladakatti, Final Year Post Graduate Scholar, Dept of PG and PhD Studies in Shalya Tantra, JSS Ayurveda Medical College, Mysuru, Karnataka, India.

⁵ I T Mallinath, Final Year Post Graduate Scholar, Department of PG and PhD Studies in Shalya Tantra, JSS Ayurveda Medical College, Mysuru, Karnataka, India.

Pilonidal sinus is a very common anorectal problem that more often arises in hair follicles of natal cleft of sacrococcygeal area. It is due to penetration of hair through skin into subcutaneous tissue.it forms unhealthy granulation tissue in deeper plane.it is of infective origin and occurs in sacral region between buttocks, umbilicus, axilla. It is common in hair dressers (seen in interdigital clefts), jeep drivers. More commonly seen in between age group of 20-40 years. It is common in males and mostly affects hairy men. Incidence of pilonidal disease is about 26 per 100,000 population. Pilonidal disease occurs predominantly in males, at a ratio of about 3-4:1. When causes, pathology, clinical symptoms and examination are taken under consideration and when we read Shalyaja Nadi Vrana mentioned by Acharya Sushruta we can corelate this disease with Pilonidal Sinus. Treatment of Nadi Vrana is Chedana Karma or with usage of Kshara Karma. Similarly in contemporary science procedure of wide excision is gold standard for management of Pilonidal Sinus, which was already mentioned by Acharya Sushruta under treatment of ‘Nadi Vrana’. We can proudly say that Pilonidal sinus can be completely managed by principles of Ayurveda. Here we report a case of Pilonidal Sinus in 35 year male patient, who had been operated 8 years back for Pilonidal Sinus. Now, he has presented with recurrence of same complaints with sinus at natal cleft region associated with pain, discharge, swelling since one month.

Keywords: Pilonidal Sinus, Shalyaja Nadi Vrana, Chedhana, Case Report

Corresponding Author	How to Cite this Article	To Browse
D Meghana, First Year Post Graduate Scholar, Department of PG and PhD Studies in Shalya Tantra, JSS Ayurveda Medical College, Mysuru, Karnataka, India. Email:	D Meghana, Siddayya Aradhyamath, J.V. Adithya, Shivakumar Aladakatti, I T Mallinath, A Single case study of Pilonidal Sinus managed through Ayurvedic Surgical Treatment Vis-à-vis through Chedhana Karma (Wide Excision). J Ayu Int Med Sci. 2022;7(5):153-158. Available From https://jaims.in/jaims/article/view/1895

Introduction

Pilonidal sinus is epithelium lined tract, situated short distance behind anus, containing hair and unhealthy diseased granulation tissue.

It is due to penetration of hair through the skin into subcutaneous tissue. It forms unhealthy granulation tissue in the deeper plane. It is of infective origin and occurs in sacral region between the buttocks, umbilicus, axilla. Pilonidal sinus usually contains hair, dirt and debris.

It can cause severe pain and can often become infected. If it becomes infected, it may ooze pus, blood and foul odour.

A Pilonidal sinus is a condition that mostly affects men and common in young adults. It’s also more common in people who sit a lot like Jeep drivers.

Ayurveda gives a complete description of Nadi Vrana and its management in Sushruta Samhita Nidana 10^th chapter and its management mentioned in Chiktsa Sthana 17^th chapter.

According to Ayurveda one who neglects a wound with full of pus and continues unhealthy foods and activities, then the pus goes deep inside, destroying the tissue (skin and muscle) because of its moving inside greatly it is known as Gati and since the spread is through a tube it is called as Nadi (sinus).

It is divided into Vataja, Pittaja, Kaphaja and Shalyaja Nadi Vrana. Here Pilonidal sinus can be co-related with Shalyaja Nadivrana

Shalyaja Nadi Vrana

Any foreign body which enters the skin/ tissue produces a sinus quickly, which exudes a warm liquid, frothy, clear /blood mixed, accompanied with pain. It can be managed through removal of Shalya (foreign body).

Here, Chedana of Shalyaja Nadi Vrana is done, Shalyaja Aharana (extraction of foreign body done) then Vrana is managed based on Shasti Upakrama told by Acharya till the wound is completely healed.

Case Report

A 35 years old male 128341/39691 came to our OPD on 28-3-2022 with complaints of pain, swelling and discharge at lower back region (Sacrococcygeal).

History of present illness

As per the statement given by the patient, he was apparently normal one month back, then he gradually noticed swelling in the lower back associated with discharge, he also had history of Pilonidal sinus 8 years back, for which he underwent surgery on the same place, now he has noticed swelling and mild pus discharge which used to aggravate on persistent sitting and used to reduce on taking rest for long duration in prone position, since 1 month.

Hence, he has approached our hospital on 28-03-2022 further management.

History of Past Illness

N/K/C/O T2DM/HTN/IHD/COPD/Thyroid dysfunction.

Surgical history

Previously he was operated for Pilonidal sinus through Z plasty method

Family History: Nothing significant.

Personal History

Ahara: Shakaahari

Vyasana: Coffee 2 times in a day

Mutra: 4 -5 times /day

Mala: once in a day.

General Examination

Built - Moderate

Appearance – Normal

Temperature - 98°F

Pulse Rate - 84 BPM

Respiration Rate -18 cycles/min

Blood Pressure -130/80 mmHg

Nourishment - Moderate

No evidence of cyanosis / koilonychia

Systemic Examination

CNS

Higher mental function test: Conscious well oriented with time, place & person.

Memory: Recent and remote: Intact

Intelligence: Intact

Hallucination/delusion/speech disturbance: Absent

Cranial nerve/sensory nerve/motor system: Normal

Gait: Normal

CVS

Inspection: No scar/pigmentation found

Auscultation: S1 and S2 heard

Percussion: Normal cardiac dullness

Inspection: B/L symmetrical,

Palpation: Trachea is centrally placed, non-tender

Auscultation: B/L NVBS heard

Percussion: Normal resonant sound

Abdomen/GIT

Soft and non-tender

No Organomegaly

Normal bowel sounds heard

Musculo Skeletal System

Gait: Normal

All range of movement: Possible

On Local Examination

Sacro coccygeal region

Shape: Oval

Swelling measuring: 4*1.5cm

On inspection

Previously operated scar marks of suture present and 5 in number

Discharge present at 3cm away posteriorly from anal canal

Redness: +

On Palpation

Tenderness: +

Induration: + +

Fluctuation: Absent

Pigmentation: + +

Investigation

USG of abdomen and pelvis (26/03/2022)

Impression - mild fatty liver.

Otherwise No Significant

Chest X Ray (26/03/2022)

PA view: Normal

Diagnosis: Pilonidal Sinus

Treatment: Chedhana Karma of Nadi Vrana (Wide excision)

Surgical Procedure

Pre-Operative

Informed consent for procedure & Spinal Anaesthesia taken.
Patient advised for NBM for 6 hours before procedure.
Injection TT 0.5ml IM injection stat given
Part preparation done
Injection Xylocaine 0.3ml S/C test dose given.
Proctolytic enema given two times before operation

Operative Procedure

Under Spinal Anesthesia Aseptic precaution Patient put on prone position
External opening identified about 5 cm of anal verge upon the previous operative scar mark
Probing done and track identified Anteriorly about 7cm from the external opening
A small nick made on skin at the end sinus track and probe is taken out.
With the probing sinus track wide excision is done in oval shape, leaving a margin of 3cms on either side of the track
Complete flap excised containing sinus track
Bleeders identified and cauterized, Haemostasis achieved
Wound thoroughly irrigated with Triphala Kashaya
Patient withstood the procedure well
Wound dressing done with Jatyadhi Taila

Post-Operative

NBM for 6 hours.
Immobilization of patient after 6 hours.
Intravenous Fluid - DNS and NS one pint, each 100 ml/ hour is profused
Catheterization done
Input and output chart maintained
Vitals Recorded every 2 hours

Treatment given: Oral medicines

1. Abhayarista (20ml-0-20ml) after food with water

2. Draksava (20ml-0-20ml) after food with water

3. Tablet Triphala Guggulu (1-0-1) after food with water

4. Tablet Gandhaka Rasayana (1-0-1) after food with water

5. Tablet Anuloma DS (0-0-1) after food with water

6. Swamla Compound (1tps-0-1tps) after food with water

Before Operation

Complete flap excised containing sinus track

Day 4 - Sinus Forceps Inserted to know the depth of the track

The depth of the sinus track was approximately 4cms deep

Day - 10

Day - 13

Day -18 Sinus track depth reduced to 1.5cm

Day 22

Day 24

Completely healed on 30th day

Advice on discharge

1. Abhayarista (20ml-0-20ml) after food with water

2. Draksava (20ml-0-20ml) after food with water

3. Tablet Triphala Guggulu (1-0-1) after food with water

4. Tablet Gandhaka Rasayana (1-0-1) after food with water

5. Tablet Anuloma DS (0-0-1) after food with water

6. Swamla Compound (1tps-0-1tps) after food with water

7. Chitrakadhi vati (2-0-2) before food with water

8. Tablet Amalaki (1-1-1) after food with water

9. Ajamamsa Rasayana (1tps-0-1tps) after food with water

Daily Wound dressing should be done with Jatyadhi Taila and Triphala Kashaya

Discussion

Pilonidal sinus is very common disease, effecting predominantly male population between age 20 to 40 years, hairy men with predominantly sedentary life style or whose occupation remains prolong sitting. Although there are newer Surgeries being tried for the management of Pilonidal sinus like Z Plasty, Limberg flap procedure, Saucerization and wide excision, laser diathermy and many more. Still all these surgery causes with high reoccurrence except for wide excision. Similarly, when we look at Acharya Sushruta concept, the main line of Nadi Vrana is Shastra Chikitsa by Chedhana Karma or by application of Kshara either as Varti or Sutra Prayoga. Hence, in this case Chedana Karma of Shalyaja Nadivrana completely on guidance of Acharya Sushruta. Except we used spinal anaesthesia for Sangya Harana for better patient compliance during entire procedure.

Conclusion

In this case of Pilonidal sinus we successfully managed case by Sushrutokta Chedhana Karma. As we have discussed regarding the pros and cons in the management of Pilonidal sinus in contemporary science all of them are associated with high recurrence rate and low success rate which is not acceptable from the patient perspective. Hence, Chedhana Karma which is having high success rate and low reoccurrence rate still holds good on first line of management for Shalyaja Nadi Vrana vis-a -vis Pilo Nidal Sinus.

Reference

1. Sriram Bhat M, SRB’s Manual of Surgery, 5th Edition Published by Jaypee Medical Publishers, p967

2. Prof. K.R Srikantha Murthy, Sushruta Samhita with English Translation of text, vol -1 edition 2017, p528-529

3. Prof. K.R Srikantha Murthy, Sushruta Samhita with English Translation of text, vol -2 edition 2017, p166-168

Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted
2022-05-02	2022-05-03	2022-05-10	2022-05-17	2022-05-24
Conflict of Interest	Funding	Ethical Approval	Plagiarism X-checker	Note
Nil	Nil	Yes	18%

Case Report

Pilonidal Sinus

Journal of Ayurveda and Integrated Medical Sciences