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
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
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
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
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
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
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
8
Q
Conservative treatment pilonidal sinus
A
- Removing hair of affected region - ideally with hair removal cream
- Keep area clean whenever possible
9
Q
Management pilonidal abscess
A
- Incision and drainage +/- washout +/- packing
- Elective surgery can then be performed at later date if patient remains symptomatic
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
11
Q
A