Abstract

MANAGEMENT OF REFRACTORY SACROCOCCYGEAL PILONIDAL SINUS (SHALYAJA NADI VRANA) VIA MINIMALLY INVASIVE PARA-SURGICAL ABLATION USING SNUHI-APAMARGA KSHARSUTRA: A CARE-COMPLIANT CLINICAL CASE REPORT

*Dr. Alok Kumar, Dr. Arjun Anil, Dr. Priyanka Barange, Dr. Elizabeth P. John, Prof. Ashok Kumar Dwivedi

Abstract

Background: Sacrococcygeal pilonidal sinus disease (PNS) is a chronic inflammatory disorder predominantly affecting the young adult male population. Characterized by hair penetration into the subcutaneous tissues of the natal cleft, it yields blind epithelized tracts presenting with recurrent suppuration and fistulization. Standard aggressive surgical methods—ranging from wide excision with secondary intention healing to advanced advancement flaps—are plagued by prolonged hospitalization, significant postoperative pain, and high recurrence indices. In classical Ayurvedic text (Sushruta Samhita), this pathology is dynamic with Shalyaja Nadi Vrana. Acharya Sushruta pioneered Ksharsutra therapy, a specialized medicated seton intervention, as a definitive minimally invasive para-surgical approach for treating deep-seated fistulous and sinus tracts. Case Presentation: A 26-year-old male heavy vehicle operator presented with a two-month history of a persistent, painful, purulent-discharging sinus within the sacrococcygeal natal cleft, refractory to conservative antibiotic regimens. Clinical assessment identified a classic pilonidal sinus tract with an indurated subcutaneous cord extending 5.5 cm. Under local infiltration anesthesia, exploratory probing, extraction of embedded hair shafts (Shalyaharana), and primary fistulotomy with immediate Snuhi-Apamarga Ksharsutra application were executed. Systemic support was sustained via Triphala Guggulu, Gandhak Rasayan, and Panchsakar Churna, coupled with daily local applications of Jatyadi Taila. Results: The medicated seton achieved simultaneous chemical debridement, tissue lysis, and synchronized healthy granulation tracking at a cutting rate of 1.0 to 1.5 cm per week. The entire pathological sinus tract was entirely ablated and epithelialized within 45 days. No adverse computational events, secondary tissue infections, or structural contour defects were recorded. At a 12-month post-procedural follow-up, the patient exhibited complete functional recovery with zero recurrence. Conclusion: This case report highlights that Snuhi-Apamarga Ksharsutra therapy constitutes a highly effective, low-cost, ambulatory, and radical alternative to radical excision, comfortably satisfying modern criteria for optimal day-care surgical interventions.

Keywords: Pilonidal Sinus, Shalyaja Nadi Vrana, Ksharsutra, Snuhi-Apamarga, Anushastra Karma, Case Report, CARE Guidelines.