Management of Sacrococcygeal Pilonidal Sinus by Ksharasutra

Abstract

Pilonidal sinus is a worldwide problem found commonly in young hirsute men. The incidence is observed to be 26/100,000 person with 3:1 male predominance. This disease clinically simulates Nadivrana (K14) described in Ayurveda. Many surgical techniques have been described and performed as a treatment for chronic pilonidal sinus. But up to 40% of patients develop recurrence and surgery may cause loss of the intergluteal tissue and other side effects. A 29-year-old nonsmoker, nonalcoholic male student with complaints of a dimple-like depression on the skin surface at upper part of intergluteal cleft associated with pain while sitting or standing, and intermittent discharge of foul-smelling pus and blood draining from the cleft visited the Outpatient Department of Central Ayurveda Research Institute for Cardiovascular Diseases, New Delhi for Ayurvedic management. On examination, there was swollen hyperemic skin around the area which is tender on palpation with hair protruding from the lesion and one visible sinus tract on the skin of cleft. It was diagnosed as pilonidal sinus. After doing the essential laboratory investigations, Ksharasutra therapy was endeavored to treat this disease under local anesthesia. The Ksharasutra was changed weekly after the initial sitting and an Ayurvedic formulation Triphala Guggulu in a dose of 1 g twice a day for 28 days was given orally and local dressing with Jatyadi Tail was performed daily for 28 days. After 28th day of therapy, the tract was completely cut out and healing was observed. There was complete resolution of symptoms like pain and discharge and the sinus tract also got healed. No side effects or adverse drug reaction was found during the therapy. After complete healing of the tract, the patient was followed up for a period of 180 days, with visits in every 30 days and no occurrence was observed. Hence, this therapy can be practiced safely for the treatment of sacrococcygeal pilonidal sinus.