Pilonidal sinus Flashcards

1
Q

What is a pilonidal sinus?

A
  • Disease of intergluteal region
  • Formation of sinus in the cleft of the buttocks
  • Most common males 16-30yrs
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2
Q

Theory of formation of pilonidal sinus

A
  • Hair follicle in intergluteal cleft
  • Becomes inflamed/infected
  • = obstruction to opening of the follicle
  • Follicle then extends inwards forming a pit instead
  • Foreign body type reaction may then lead to formation of cavity connected to surface of skin via epithelialised sinus tract
  • These fluid filled cavities will often discharge serous fluid and can periodically become acutely infected forming abscess
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3
Q

RF for pilonidal sinus

A
  • Caucasian male
  • Coarse dark body hair
  • Sit for prolonged periods eg lorry drivers or office workers

Others: increased sweating, buttock friction, poor hygiene

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4
Q

Symptoms of pilonidal sinus

A
  • Discharging and intermittently painful sinus in sacrococcygyeal region
  • Discharge is episodic and serous - but can become bloody or purulent on occasion
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5
Q

What is a pilonidal abscess?

A
  • When pilonidal sinus becomes infected
  • Presents as swollen and erythematous
  • Fluctuant and tender mass
  • Systemic features of infection
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6
Q

Pilonidal disease vs perianal disease

A
  • Pilonidal disease lying low can be difficult to distinguish between perianal fistula
  • Protoscopy and MRI need to be used for assessment
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7
Q

Investigations for pilonidal sinus

A
  • Diagnosed and managed without investigations
  • If extensive or complex - multi pit or previous surgery, can do MRI scarum to help operation planning
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8
Q

Conservative treatment pilonidal sinus

A
  • Removing hair of affected region - ideally with hair removal cream
  • Keep area clean whenever possible
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9
Q

Management pilonidal abscess

A
  • Incision and drainage +/- washout +/- packing
  • Elective surgery can then be performed at later date if patient remains symptomatic
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10
Q

Elective surgical management pilonidal sinus

A
  • Excision and laying open or excision and primary closure (Karydakis procedure) - uncomplicated simple disease
  • Excision and advancement flaps (eg V-Y flap) or excision and rotational flaps (eg Limberg flap) - advanced disease
  • Newer approaches are endoscopic pilonidal sinus treatment - cauterisation and cleaning
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11
Q
A
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