Journal of Ayurveda and Integrated Medical Sciences

Pilonidal sinus is a common condition that has controversies regarding its aetiology and treatment since its first description in the mid-19^th century. The term is derived from a set of Latin words “pilus” meaning hair, and “nidus”, meaning nest. It is popularly known as “Jeep Riders Disease”. During the world war, over 80000 soldiers in the United States army were hospitalised with this condition. Because a large number of soldiers who were being hospitalised for pilonidal sinus rode in jeeps, it was termed as jeep riders’ disease. Pilonidal sinus is an acquired disease. Formerly, the theory of congenital origin was very popular but now a day it has greatly declined. It is epithelium lined tract, situated short distance behind the anus, containing hairs and unhealthy diseased granulation tissue. It develops due to penetration of hairs through the skin into subcutaneous tissue. It forms unhealthy granulation tissue in the deeper plane. The most important predisposing factor for the development of Pilonidal sinus are the existence of deep natal cleft and the presence of hair within the cleft. A deep natal cleft is a favourable atmosphere for maceration, sweating, bacterial contamination and penetration of hairs. Thus, for treatment and prevention, these causative factors must be eliminated.

Pilonidal sinus has three common representations. Nearly all patients have an episode of acute abscess formation. When this abscess resolves, either spontaneously or with medical assistance, many patients will develop chronic disease or recurrent disease after treatment. On examination typically reveals one or more small (1-2mm) dermal pits at the base of intergluteal cleft.

Tracking from the pits (usually in cranial and lateral direction) will appear as an area of induration. With an associated abscess, the diseased area may be tender and erythematous, and draining pus may be evident. The more extensive the disease, the more prominent the findings. Commonly performed operations are complete excision with primary suture, complete excision without skin suture, laying open of the tract with marsupialization of wound etc. Different forms of surgical techniques for pilonidal sinus have been advocated, but none of them provide good results, as the post-operative recurrences are very common.

A female patient of 24 years visited Shalya Tantra OPD of Sri Kalabyraveshwara Swamy Ayurvedic Medical College and Hospital and Research Center with the OPD number of K12578

With the complaints of pain, swelling, discharge from natal cleft from 3 months. Patient had a history of same complaints 1 year ago so she visited a nearby hospital and there she was diagnosed with pilonoidal sinus took treatment and had under gone laser surgery. Gradually after 9 months a small opening felt by patient near gluteal cleft with pain and discharge. Patient had no history of bleeding per rectum or painful defecation or mucus or any kind of discharge through anus. There is no history of Diabetes mellitus, Hypertension, Tuberculosis, etc. Patient had good appetite, bowel habit, sleep, not any kind of addiction. Blood pressure, pulse rate, respiratory rate was in normal limits.

Local Examination: Local examination was done in prone position of patient, the findings were: patient was hairy and had a small opening at mid gluteal cleft with good amount of hair nearby. During palpation, a cord like indurated structure was felt at the opening of sinus. Mild tenderness and watery discharge were present while palpation of local site. There was no any other opening or any lump near or in gluteal cleft. Probing was done from the opening to accessed branching and extension of the tract. About 5 cm tract was found during probing in mid gluteal cleft.

The modern surgical treatment of Pilonidal sinus is often unsatisfactory. In majority of cases, recurrences are common after surgery. Kshara Sutra is safe, cost effective and minimally invasive procedure, promotes healthy healing with negligible recurrence rate. Management of pilonidal sinus with Chitaka Kshara Sutra is found to be very effective, and can be successfully used as a curative measure in cases of Pilonidal sinus.

1. S. Das: A concise text book of surgery, publisher Dr. S Das, 5th edition reprinted 2009, chapter 54, pg no-1099.

2. Bailey & Love’s short practice of surgery, 27th edition, pg no-1347.

3. Sushruta, Sushruta Samhita-edited with Ayurveda Tatwa sandipika Hindi commentary by Kaviraja Ambikadutta Shastri, Choukhambha Sanskrit Sansthan; 2010, Vol1, Nidana Sthana 10/9-14.

4. Dravyaguna Vijnana; Prakash L Hegde, Choukhambha publications, New Delhi, chapter-75, page no-320.