Pilonidal Sinus Flashcards
What is a pilonidal sinus?
Pilonidal sinus disease is a disease of the inter-gluteal region, characterised by the formation of a sinus in the cleft of the buttocks.
Who is commonly affected by pilonidal sinus?
It most commonly affects males aged 16-30 years.
Briefly describe the pathophysiology of pilonidal sinus
The most widely accepted theory for pilonidal sinus disease development is starting from a hair follicle in the intergluteal cleft becoming infected or inflamed.
This inflammation obstructs the opening of the follicle, which extends inwards, forming a ‘pit’ (a characteristic feature of pilonidal sinus disease). A foreign body-type reaction may then lead to formation of a cavity, connected to the surface of the skin by an epithelialised sinus tract.
What are the risk factors for a pilondial sinus?
Pilonidal sinus disease most commonly affects Caucasian males with coarse dark body hair. Classically, it is associated with those who sit for prolonged periods, such as lorry drivers or office workers.
Other associated factors are increased sweating, buttock friction, obesity, poor hygiene, or local trauma. Typically, pilonidal disease does not occur after 45 years of age.
What are the clinical features of a pilondial sinus?
Pilonidal sinus disease most commonly presents as a discharging and intermittently painful sinus in the sacrococcygeal region.
A pilonidal abscess can form when a pilonidal sinus becomes infected. This will present as a swollen and erythematous region. On examination, there will be a fluctuant and tender mass, as well as systemic features of infection.
How does the presentation of a pilondial sinus and perianal fistula differ?
The main distinguishing feature compared to a perianal fistula is that a pilonidal sinus does not communicate with the anal canal; if there is any uncertainty on initial inspection, a rigid sigmoidoscopy or MRI imaging can be performed to assess for any internal opening of a tract.
What is shown on image A?
(A) Openings of two pilonidal sinuses
What is shown on image B?
(B) A pilonidal abscess
Briefly describe the conservative management of a pilonidal sinus
Pilonidal disease eases with age and does not always require surgical management.
Conservative treatment of a pilonidal sinus involves shaving the affected region and plucking the sinus free of any hair that is embedded. Any accessible sinuses can be washed out with water to prevent infection.
Whilst antibiotics can be used in septic episodes, any abscess present will require surgical drainage.
Briefly describe the treatment for a pilondial sinus with an abscess
For any abscess that has developed, an incision and drainage with washout is required. It can be difficult to remove the sinus tract in the same operation and patients may require further surgery.
Briefly describe the surgical treatment of a pilonidal sinus
Treatment of chronic disease is the removal of the pilonidal sinus tract. There are two main methods:
- Excision of the tract and laying open the wound, allowing closure by secondary intention
- Excision of the tract, followed by primary closure of the wound
