An Unusual Presentation of Pilonidal Sinus in the Anterior Perineum: A Rare Case Report

Abstract

Pilonidal sinus (PNS) is a chronic inflammatory condition that most commonly occurs in the natal cleft (intergluteal region), where it typically presents as one or more sinus tracts with small cutaneous openings, intermittent purulent discharge, pain, swelling, or recurrent abscess formation. It is thought to result primarily from the penetration and subsequent inflammation of loose hairs into the skin, with factors such as local friction, prolonged sitting, obesity, excessive hair growth, and poor local hygiene contributing to its development. Involvement of the anterior perineum is exceptionally uncommon and represents an unusual anatomical presentation of pilonidal disease. In Ayurveda, can be corelate with Nadi Vrana, although a direct classical equivalent of pilonidal sinus has not been clearly established. We report the case of an 18-year-old male who presented with two openings in the anterior perineal region associated with intermittent purulent discharge. The condition was clinically diagnosed as pilonidal sinus and subsequently confirmed intraoperatively.  The patient underwent totally surgical excision followed by wound care involving dressing with Apamarga Kshara Taila, sitz bath with Sphatika churna with luke warm water and in addition oral Ayurvedic formulation Kanchanara Guggulu 500 mg two tablets twice daily, Varunadi kwatha 15 ml +30 ml warm water twice daily was administered orally. The postoperative wound complete healed within 40 days, without complication or infection. No recurrence was observed during six-months follow-up period. This case highlights the potential role of surgical interventions in enhancing postoperative recovery and minimizing recurrence in Anterior Perineum Pilonidal Sinus.