Majority of patients affected by Pilonidal Sinus disease come with the complaints of pain, swelling, pus discharge and difficulty in sitting around the tail bone area. Few patients complain that  after discharge of pus they feel better for few days to months and again same problem happens to them. Most of the patients are in the age group of twenty to thirty years. It is common in males and mostly affects hairy males.

Pilonidal = pilus i.e. hair, nidus i.e. nest and Sinus =  a tract which is blind at one end.

Pilonidal Sinus means a tract lined by epithelium, containing hair & unhealthy granulation tissue or a sinus containing free tuft of hairs.

Common Sites

•          Skin covering the sacrum & coccyx

•          In the web spaces between the fingers in hair dressers.

•          Usually seen in hairy persons.

Causes of  Pilonidal Sinus

•          Majority of pilonidal sinuses are of acquired variety.

•          Rarely a congenital sinus.

•          Mechanical factor theory- due to vibration and friction shedding of the hair occurs. Thus it enters in the gluteal cleft and into the opening of the sweat glands.

Features

•          Pain & swelling  around the tail bone area.

•          Pus or bloody discharge around tailbone area

•          Unexpected moisture in the tailbone area

•          Discomfort with sitting on the tailbone.

Diagnosis of  Pilonidal Sinus

•          History of the patient.

•          Examination of the patient.

•          Probing of the sinus tract under local anaesthesia

•          Sinogram of the tract

•          MRI

Risk Factors

•          Obesity.

•          Family history.

•          Prolonged sitting.

•          Greater amount of hair.

•          Not enough exercise

Management

•          Conservative treatment has minimal  role in curing the disease .

•          Keeping in mind the recurrence of disease, we prefer to manage it with kshar sutra therapy  which is done under local anaesthesia. After application of kshar sutra, patient is advised for change of sutra after every seven to ten days till patient gets recovered.

 

Case Report

Patient Name: Mr Rajinder Singh

Age : 28 Yrs

Address: Vill & P.O. Nawn Thatta, Sultanpur Lodhi, Distt. Kapurthala, Punjab.

O.P.D. NO: 3678/603

Job:  Businessman at Beharin

Symptoms

•          Pain, swelling & difficulty in sitting with pus discharge  from last 4-5 yrs

•          Past history of management-Surgery three times since 2012 for the same problem. Even after surgery, he was having same complaints.

On Examination

Inspection:

•          Scar mark of previous surgery seen around the tail bone area.

•          Opening seen around the tail bone area.

Palpation:

•          Tenderness +ve around the tail bone area.

•          Expression of pus from the opening

Blood Test: Normal

Diagnosis :  Recurrent Pilonidal Sinus.

Procedure: Kshar Sutra application done under local anaesthesia on 2-03-2017.

Follow up: Kshar sutra changed after an interval of 7-10 days till the patient get fully recovered.