E-ISSN:2456-3110

Case Report

Multiple opening Pilonidal Sinus

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 2 February
Publisherwww.maharshicharaka.in

Integrated approach in multiple opening Pilonidal Sinus by Chedana Karma, Ksharakarma and Jathyadi Ghrita: A Case Report

Sreenath Ps1*, Rakhy M2
DOI:10.21760/jaims.9.2.51

1* Sreenath Ps, Assistant Professor, Dept of Shalya Tantra, Ahalia Ayurveda Medical College Hospital, Palakkad, Kerala, India.

2 Rakhy M, Assistant Professor, Dept of Shalya Tantra, Ahalia Ayurveda Medical College Hospital, Palakkad, Kerala, India.

Pilonidal sinus is one among diseases of rectum and anal canal where usually a hair gets caught inside the skin near the sacral region between the buttocks. It is associated with foul smelling pus discharge and pain. Usually seen in jeep drivers and hair dressers.[1] Normal treatment followed is z plasty. But the healing of the wound is a challenging task. Here is a case of multiple opening pilonidal sinus of a 28 year old male where an integrative approach has been done successfully and the wound is applied with Kshara and finally daily dressing done with Jathyadi Ghrita is administered.

Keywords: Jathyadi Ghrita, Kshara, pilonidal sinus, Z-plasty

Corresponding Author How to Cite this Article To Browse
Sreenath Ps, Assistant Professor, Dept of Shalya Tantra, Ahalia Ayurveda Medical College Hospital, Palakkad, Kerala, India.
Email: 		Sreenath Ps, Rakhy M, Integrated approach in multiple opening Pilonidal Sinus by Chedana Karma, Ksharakarma and Jathyadi Ghrita: A Case Report. J Ayu Int Med Sci. 2024;9(2):316-320.
Available From
https://jaims.in/jaims/article/view/3114

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-12-14 2023-12-24 2024-01-04 2024-01-14 2024-01-22
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None declared Nil Yes 21.74

© 2024by Sreenath Ps, Rakhy Mand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Sreenath PS et al. Integrated approach in multiple opening Pilonidal Sinus

Introduction

Pilonidal sinus is an infectious condition that typically occurs in the sacral region between the buttocks, umbilicus and axilla. It is characterized by the presence of hair, dirt, and debris within the sinus. This condition can cause severe pain and often leads to infection, resulting in the discharge of pus, blood, and a foul odor. Pilonidal sinus primarily affects men, especially young adults, and is more common in individuals who spend prolonged periods sitting, such as Jeep drivers.[1] In Ayurveda, Nadi Vrana, a condition similar to Pilonidal sinus, is described in detail in the 10th chapter of Sushruta Samhita Nidana and its management is mentioned in the 17th chapter of Chiktsa Sthana. According to Ayurveda, when a wound with pus is

neglected and unhealthy foods and activities are continued, the pus penetrates deep into the tissues (skin and muscle), resulting in tissue destruction. This condition is referred to as Gati due to the movement of pus and Nadi (sinus) due to its spread through a tube. Nadi Vrana is further classified into Vataja. Pittaja, Kaphaja, and Shalyaja Nadi Vrana.[2] In the case of Pilonidal sinus, it can be correlated with Shalvaja Nadivrana. The management of Shalyaja Nadivrana involves the removal of the foreign body (Shalya) through Chedana and Ksharakarma.[3] Once the foreign body is extracted (Shalyaja Aharana), the wound is treated according to the Shasti Upakrama prescribed by Acharya until complete healing is achieved.

Presenting complaints

Patient complains of pain in the right side of cleavage of buttocks associated with pus discharge since 2 years and the symptoms aggravated since 1 week.

History of present illness

Patient 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 2 years Back, for which he underwent surgery. Now he has noticed swelling and mild pus Discharge which used to aggravate on persistent sitting. For the same he came for admission in our hospital.

History of Past Illness: N/K/C/O T2DM/HTN/IHD/COPD/Thyroid dysfunction.

Surgical history

Previously he was operated for the same.

Family History

Nothing significant.

Personal History

Diet: mixed

Habits: Coffee 2 times in a day

Maturation: 4 - 5 times /day

Bowel: 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.

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

RS

Inspection: B/L symmetrical,


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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: 9.5*3cm

On inspection

Previously operated scar marks of suture present

Discharge present at 13cm away posteriorly from anal

Canal

Redness: +

On Palpation

Tenderness: +

In duration: + +

Fluctuation: Absent

Pigmentation: + +

Investigation

USG of abdomen and pelvis

Impression - No Significant abnormality detected.

Chest X Ray

PA view: Normal

Diagnosis: Pilonidal Sinus

Treatment

Chedhana Karma of Nadi Vrana (Wide excision) & Ksharakarma

Surgical Procedure

Pre-Operative

Informed consent for the procedure

Patient advised for NBM for 2 hours before procedure.

Injection TT 0.5ml IM injection stat given

Part preparation done

Injection Xylocaine 2% - 0.3ml S/C test dose given.

Proctoclysis enema given two times before operation

Operative Procedure

Under local anesthesia

Aseptic precaution

Patient put on prone position

External opening identified about 3.5 cm of anal verge upon the previous operative scar mark

Probing done and track identified. Anteriorly about 9.5cm 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 were identified and cauterized

Ksharakarma done using Apamarga Kshara and washed with Nimbu Swarasa.

Hemostasis achieved

Wound dressing done with Jathyadi Ghrita.

Post-Operative

Intravenous Fluid

DNS one pint 100 ml/ hour infused.

Vitals Recorded every 2 hours

Oral medicines

1. Abhayarista (15ml-0-15ml) after food with water
2. Tablet Triphala Guggulu (2-0-2) after food
3. Tablet Gandaka Rasayana (2-0-2) after food
4. Tablet Anuloma DS 2hs before food


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External treatment

Sitz bath with Triphala powder bd

Daily wound cleaning and dressing with Jathyadi Ghrita.

jaims_3114_01.JPG
Before treatment

jaims_3114_02.JPG
Probing before operative procedure

jaims_3114_03.JPG
Intra op- Wide excision done

jaims_3114_04.JPG
After Ksharakarma

jaims_3114_05.JPG
Post op day 1 applying Jathyadi Ghrita

jaims_3114_06.JPG
Post op day 20


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jaims_3114_07.JPG
Post op day 35

Discussion

Pilonidal sinus is a fairly common condition that primarily affects men between the ages of 20 and 40. It is usually observed in individuals with a sedentary lifestyle or those who spend prolonged periods of sitting, especially if they have a hairy back. While there have been various surgeries attempted to address Pilonidal sinus, such as Z Plasty, Limberg flap procedure, Saucerization, wide excision, laser diathermy, and more, many of them have shown a high rate of recurrence, except for wide excision. Interestingly, when we explore Acharya Sushruta's teachings, the main approach for treating Nadi Vrana (Pilonidal sinus) involves Shastra Chikitsa through Chedhana Karma or the application of Kshara, either as Varti or Sutra Prayoga.[4] In this particular case, we followed Acharya Sushruta's guidance and performed Chedana Karma of Shalyaja Nadivrana, with the added use of local anesthesia for Sangyaharana to enhance patient comfort throughout the procedure.

Conclusion

This case was successfully managed by means of Sushrutokta Chedhana Karma. Chedhana Karma along with Ksharakarma holds high success rate and low recurrence rate hence considered as first line of management for Shalyaja Nadi Vrana vis-a -vis Pilonidal Sinus.

References

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

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

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

4. Meghana D, Siddayya Aradhyamath, Adithya J.V., Shivakumar Aladakatti, Mallinath I T. A Single case study of Pilonidal Sinus managed through Ayurvedic Surgical Treatment Vis-à-vis through Chedhana Karma (Wide Excision). J Ayurveda Integr Med Sci 2022;5:153-158.


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