HTML Full Text

Introduction

In Greek, pilonidal sinus means "nest of hairs." It is an acquired disorder that is typically seen in men with hair. The hair follicle in the pilonidal sinus wall is never visible. Friction and vibration build up on the hair, causing it to shed. As a result, it builds up in the gluteal cleft and gets into the sweat gland aperture. The sinus track runs between the buttocks in a vertical orientation. Similar to the Sushruta Samhita, Shalyaja Nadivrana is described as having a foreign body stuck inside it, which causes constant pain and discharge because of the presence of hair, pus, necrosed tissue, etc. Thus, it is evident how similar Shalyaja Nadivrana is.

Because of this, Sushruta has developed a very special, minimally invasive treatment called Ksharsutra in Nadivrana, which not only reduces complications and recurrences but also makes early working easier. These days, excision, primary closure, and excision with reconstructive flap are the most often utilized surgical techniques for this illness; in other words, it is closed with "z" plasty. Patients must stay in the hospital for longer, nevertheless, because of the possibility of recurrence and wound infection. Thus, Ksharsutra therapy lowers inflammation and clears the infection's path, lowering the likelihood of consequences.

Case Report 

Patient name: XYZ

Age: 47yrs

Date of 1st visit: 28/08/2023

Date of recovery: 10 /10/2023

 

Chief Complaints with duration:

1. A small opening at sacro-coccygeal region since 3 months

2. Mild pain & pus discharge from the opening since 3 months

3. Itching at same site since 1month

H/O present illness: Patient was perfectly alright before 3 months but gradually developed above complaints all of sudden. Now he had taken analgesics for it, but didn’t get relief. Therefore for further evaluation and management he came in Vidarbha Ayurveda Mahavidhyalaya and

  hospital, Amaravati.

Family History: 

No H/O HTN, DM, TSH or any other major illness. 

Addiction: Not any

Prakruti Vinischaya: Kaphpradhan pittaj

img

General Examination: GC - moderate

                                                 Temp – afebrile

                                         CVS-S1 S2 normal

                                         BP: 130/80 mmhg

                                        Pulse: 76/min

                                        SPO2: 96%

                                         RS: chest clear on both side

                                         Digestive system: regular bowel habbit

                                         Uro-genital system: NAD

Local Examination: 

• A small sinus near sacro-coccygeal region.
• Pus discharge through opening.
• Tenderness++
• Swelling mild

Cause: Aagantuj Shalyaja nadi vrana

Diagnosis: According to modern medicine – Pilonidal Sinus

Treatment: 

• 1. Ksharsutra application: 
• Following test like TB, HIV, HBsAg, DM should be ruled out before performing the procedure.
• ↓AAP ↓Spinal anesthesia, the probe was inserted through opening and passed downward direction upto 5cm.
• Another small nick opening is given on the tip of probe so as to make 1 opening and the embedded hair follicles were removed out with help of mosquito forcep.
• So there were total 2 tracks. Again probe was inserted and above tract continued downward upto 2cm incision taken & probe removed.
• The Ksharsutra was tied covering the entire tract for simultaneous cutting and healing.
• The Ksharsutra was changed weekly for 14 settings. To reduce inflammation oral antibiotics and anti- inflammatory drugs were prescribed.

• 1. Oral medication: 
• Triphala churna- 1 tsp HS
• Sukshma Triphala – 2tab TDS
• Hot sitz Bath: twice in a day

Observation: 

The sinus track was punctured and healed 7 weeks apart after the track has fully healed.

     The entire track was covered with the Ksharsutra, allowing for simultaneous cutting  and healing.

Discussion

Ksharsutra is a medicinal caustic thread coated in alkaline medicines made from herbs, such as powdered curcurmalonga (Haridra) and latex made from udumber (Ficus rcemosa), which serves as a binding agent.

In addition to acting locally as an anti-fungal, anti-bacterial, and anti-inflammatory agent, this combination of medication coating on thread aids in the debridement of necrosed tissues and promotes the formation of healthy granulation tissue.

Conclusion

Pilonidal sinus is satisfactorily managed with this Ksharsutra treatment. In addition to  curing the condition, it also reduces the likelihood of complications and   recurrences and, in a short amount of time, allows the patient to return to ork and engage in regular social activities. When it comes to treatment costs, this therapy is good.