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Pilonidal sinus (Nadi vrana)

Published by : ayurdoctor on:01-09-13 06:47 PM
Dr Pradeep S Shindhe.,
Dr Hemanth D.T,
DR S. V. Emmi ,
DR Shilpa M P,
DR Pallavi Hegde

Dept.of Shalytantra (surgery),
KLEU Shri B. M.K.Ayurveda Mahavidhyalaya,
Bealgaum

Abstract
A pilonidal sinus (PNS) occurs in the cleavage between the buttocks (natal cleft) and can cause discomfort, embarrassment and absence from work for thousands of young people (mostly men) annually. It is a common problem in primary care due to recurrence following surgery and the need for frequent and time-consuming wound care. This article covers the pathology, clinical presentations and appropriate management of pilonidal sinus disease with kshara sutra therapy.

We report a case of twenty two years old boy, approached us with complaints of fistula-in-ano. And previously operated for the same two years back.

Introduction
Pilonidal disease was first described by Hodges in 1880 and is diagnosed by the finding of a characteristic epithelial track (the sinus) situated in the skin of the natal cleft, a short distance behind the anus and generally containing hair, hence the name pilonidal taken from the Latin, meaning literally 'nest of hairs'. During the Second World War the condition was common in jeep drivers, which led to it being known as 'jeep disease'. A similar condition arises in the clefts between the fingers of barbers or hairdressers caused by customers' hair entering moist, damaged skin.

In ayurvedic text we don't get direct reference of pilonidal sinus as disease entity, but Sushruta father of surgery has explained hair can be a route cause for formation of sinus,and its management by different modalities like agnikarma and ksharasutra.

Case Report
Twenty two year old boy, approached us with complaints of pain and pus discharge from anal verge,with intermittent fever since 2 years. On local examination there was scar measuring four centimeters at five 'o'clock position with two external openings on either end of the scar at about nine centimeters away from anal verge. Routine investigations were within normal limits,intraoperativly a dye was introduced through external opening to see any connection with anus. Fortunatly it was seen that the dye was coming from natalcleft. An elliptical inscion over the natalcleft was taken to excise the sinus till pre-sacral fascia and bunch of hairs where removedAllowed for healing by secondary intention. For remaining tract measuring about nine centimerets, extending from base of natalcleft to the external opening over the scar at five 'o'clock position was threaded with Apamarg Ksharasutra. The remification-communicants were treated with kshravarti(alkali suppositories).

Postoperative course was uneventfull, Apamarg Ksharasutra was changed weekly on day care bases, which was continued till the complete cutting of the tract. This event took four weeks for complete healing.

Discussion
The commonly adopted surgical techniques in contemporary science are I) incision and drainage, ii) excision and healing by secondary intention, iii) excision and primary closure, iv) excision with reconstructive flap techniques. In the present case as external openings was far away from natal cleft and many remifications were present for the main sinus, so excision and healing by secondary intention was adopted pilonidal sinus. Kshra (alkaly) and it's different modalities like Ksharavarti, ksharasutra etc are the unique contribution of ancient science. As these drugs posses both curetting and healing properties, so ksharasutra was used for threading in between main sinus and external opening which was approximately nine centimeter. Patient was followed regulary and ksharasutra was changed weekly for four weeks.

Conclusion
Pilonidal disease is a complex condition that causes both discomfort and embarrassment to sufferers. Direct costs to the healthcare system and indirect costs through absence from work. Regardless of the surgical technique concerned, standard principles of wound care are essential with repeated depilation of the natal cleft, removal of hair and any debris from the wound bed and keeping the wound edges separated using an appropriate dressing.
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