[30] Pilonodal Sinus Flashcards

1
Q

What is pilonodal sinus disease?

A

A disease of the anorectal region characterised by formation of a sinus in the cleft of the buttocks

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2
Q

Who does pilonodal sinus disease most commonly affect?

A

Males aged 15-30years, with coarse, dark body hair

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3
Q

What is the most widely accepted theory for pilonodal sinus disease development?

A

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

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4
Q

What behaviour is pilonodal sinus disease classically associated with?

A

Sitting for prolonged periods, e.g. lorry and taxi drivers

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5
Q

What are the risk factors for pilonodal sinus disease?

A
Increased sweating
Prolonged sitting
Buttock friction
Obesity
Poor hygeine
Local trauma
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6
Q

When does pilosinus disease typically not occur?

A

After 45 years of age

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7
Q

How does pilonodal sinus disease most commonly present?

A

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

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8
Q

What is the main distinguishing feature of a pilonodal sinus from other anorectal conditions, such as anal fistulae?

A

It opens up into the skin, but does not continue into the anal canal like a fistula

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9
Q

How is it determined that an opening in the skin doesn’t extent into the anal canal?

A

Rigid sigmoidoscopy in clinic

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10
Q

How can extensive pilonodal sinus formation and fistulisation be assessed?

A

By MRI scanning of the natal cleft and buttocks

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11
Q

Why is surgery not always required for pilonodal sinuses?

A

Because pilonodal sinus disease eases with age

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12
Q

What is involved in the conservative treatment of a pilonodal sinus?

A

Shaving the affected region
Plucking the sinus free of any hair that is embedded
Washing out of accessing sinuses

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13
Q

What can be used in septic episodes in pilonodal sinus disease?

A

Antibiotics

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14
Q

What is required for any pilonodal abscesses?

A

Surgical drainage

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15
Q

What is the exact surgical management of a pilonodal sinus dependant on?

A

Wether the disease is acute or chronic

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16
Q

What does surgical management involve in acute pilonodal sinus disease?

A

Drainage and washout of any abscess that is present

17
Q

What is the limitation of surgical intervention in pilonodal sinus disease?

A

It can be difficult to remove the sinus in the same operation as it is drained and washed out , and so most patients will require further surgery

18
Q

How is chronic pilonodal sinus disease treated?

A

With the removal of the pilonodal sinus tract

19
Q

What are the main methods of removal of the pilonodal sinus tract?

A

Excising the tract and laying open the wound, allowing closure by secondary intention
Excising the tract followed by primary closure of the wound

20
Q

What is the advantage of exising the pilonodal tract and laying open the wound, allowing closure by secondary intention?

A

Low rates of recurrence

21
Q

What is the disadvantage of exising the pilonodal tract and laying open the wound, allowing closure by secondary intention?

A

Can take a long time to heal

Increased risk of infection

22
Q

What is the disadvantage of exising the pilonodal tract followed by primary closure of the wound?

A

Higher rates of recurrence

Patients may require reconstructive surgery due to tissue loss from this operation