Pilonidal sinus

Question 1

What is a pilonidal sinus? Aetiology?

Answer 1

Obstruction of natal cleft hair follicles around 6cm above the anus. Ingrowing of hair excites a foreign body reaction and may cause secondary tracks to open laterally +/- abscesses, with foul-smelling discharge.

Question 2

What are the risk factors for pilonidal sinus? (x10)

Answer 2

Male, obese, prolonged sitting, greater amounts of hair, excessive sweating, Caucasians, Asians, the Middle East and Mediterranean, barbers (between fingers).

Question 3

What is the epidemiology of pilonidal sinus: Incidence? Gender? Age?

Answer 3

3 per 10 000 per year, men:female 10:1. More common in young adults.

Question 4

What are the symptoms of pilonidal sinus? (x3)

Answer 4

o Intermittent pain/discomfort or swelling above the anus (near the coccyx)

o Moisture in the region

o Discomfort during sitting

Question 5

What are the investigations for pilonidal sinus?

Answer 5

Through examination and history alone.

Question 6

How are pilonidal sinuses managed surgically?

Answer 6

o Excision of the sinus (channel) tract and usually left open to heal. Daily packing may be considered until complete granulation. Consider pre-op antibiotics.

o Reconstructive flap technique where skin flaps are used to cover the defect post-op. Used for complex tracts.

Question 7

What advice would you give to prevent pilonidal sinus recurrence? (x2)

Answer 7

Offer hygiene and hair removal advice.