Coexisting pilonidal sinus and anal fistula: Successful management with minimal invasive Kshara Karma Technique and Ksharasutra therapy- A case report.

Pilonidal sinus (PNS) is a nest of hair which typically presents as pits, pus discharge, and an abscess at the natal cleft region. In rare conditions where pilonidal abscess is not drained properly, it progresses posteriorly and reaches anal canal, eventually coexisting with anal fistula. Both are associated with a high recurrence rate despite surgical management. A 27 year old female patient presented with complaints of non-healing wound in the natal cleft region and pus discharge from wound for 2 months with a past surgical history for PNS. On local examination, a wound was seen at the natal cleft, secondary pit 3cm away with scar mark of the previous operation, and a digital rectal examination (DRE) revealed an internal opening at 6 o'clock position that was communicating with the previously operated PNS wound. The patient was diagnosed as a case of coexisting anal fistula and recurrent PNS. Patient was managed under spinal anaesthesia with interception of fistulous tract using Ksharasutra (Medicated alkaline thread), followed by Minimal Invasive Kshara Karma Technique (MIKKT) for PNS. Ksharasutra was sloughed out after the fifth week, and complete wound healing of PNS was achieved in six weeks. By interception of the fistulous tract, the length of the tract was reduced, which facilitated early wound healing and minimal scar mark formation. MIKKT also prevented bigger excision and wound formation, eventually reducing complete healing duration, and Kshara(a medicated alkali) applied caused chemical cauterization and hence prevented recurrence of pilonidal sinus.