[30] Pilonodal Sinus Flashcards
What is pilonodal sinus disease?
A disease of the anorectal region characterised by formation of a sinus in the cleft of the buttocks
Who does pilonodal sinus disease most commonly affect?
Males aged 15-30years, with coarse, dark body hair
What is the most widely accepted theory for pilonodal sinus disease development?
A hair follicle in the intergluteal cleft becomes infected or inflamed. This inflammation obstructs the opening of the follicle, which extends inwards, forming a ‘pit’. A foreign-body type reaction may then lead to the formation of a cavity, connected to the surface of the skin by an epithelialised sinus tract
What behaviour is pilonodal sinus disease classically associated with?
Sitting for prolonged periods, e.g. lorry and taxi drivers
What are the risk factors for pilonodal sinus disease?
Increased sweating Prolonged sitting Buttock friction Obesity Poor hygeine Local trauma
When does pilosinus disease typically not occur?
After 45 years of age
How does pilonodal sinus disease most commonly present?
As an intermittent red, painful, and swollen mass in the sacrococcygeal region. There is commonly discharge from the sinus, and there may be systemic features of infection
What is the main distinguishing feature of a pilonodal sinus from other anorectal conditions, such as anal fistulae?
It opens up into the skin, but does not continue into the anal canal like a fistula
How is it determined that an opening in the skin doesn’t extent into the anal canal?
Rigid sigmoidoscopy in clinic
How can extensive pilonodal sinus formation and fistulisation be assessed?
By MRI scanning of the natal cleft and buttocks
Why is surgery not always required for pilonodal sinuses?
Because pilonodal sinus disease eases with age
What is involved in the conservative treatment of a pilonodal sinus?
Shaving the affected region
Plucking the sinus free of any hair that is embedded
Washing out of accessing sinuses
What can be used in septic episodes in pilonodal sinus disease?
Antibiotics
What is required for any pilonodal abscesses?
Surgical drainage
What is the exact surgical management of a pilonodal sinus dependant on?
Wether the disease is acute or chronic