Pilonidal Fistula

Question 1

What is Pilonidal Fistula?

Answer 1

It is a congenital disease (epithelial cyst of coccygeal bone, posterior umbilicus)
It mainly affects men

Question 2

Etiology and Pathogenesis of Pilonidal Fistula

Answer 2

Due to incomplete reduction of a tail in mans embryo
It is situated under the skin of sacrococcygeal region at the medial line and represents a narrow canal covered with skin epithelium which blindly ends 4-6cm higher than the anus
In the depth of the inter gluteal fold there are funnel shaped skin retractions
Dotty pores existing in the skin retractions act as communication of the fistula with outdoor environment and as entry of infection

Question 3

Clinical picture of Pilonidal Fistula

Answer 3

Becomes clinically evident at 16-25 yrs when endocrine glands and skin epithelium function intensively
Pilonidal Fistulas may be complicated or uncomplicated

Complicated have stages of acute and chronic inflammation and remission

If there is discharge retention of epithelial vital activity product, the patient notices that a small slightly painful infiltrate appears
Incase of infection of the infiltrate contents, pain intensifies and abscess forms
If there is movement of the abscess through the skin, Fistulas or secondary orrifice forms

Question 4

Diagnosis of Pilonidal Fistula

Answer 4

From patients complaints of pain and presence of tumor mass in the region of the intergluteal fold, mucus and purulent discharge from fistula
Primary orifices- funnel shaped skin retractions

Differential diagnosis

• pyoderma
• rectal fistula
• osteomyelitis
• furuncules of this region
• acute anal abscess
• presacral cysts

Question 5

Treatment of Pilonidal Fistula

Answer 5

Surgical treatment is done

Incase of P.F complicated with abscess operation of cutting and draining of pyogenic abscess is done , the abscess is situated in subcutaneous fat
Elective radical surgery is done 1,5-2 months after subsidizing of the acute condition

Radical surgery consists of excision the of Pilonidal Fistula and all secondary sinus tracts and fistulous openings
Management of postoperative wound is done and patients are discharged on the 8th-14th day after operation