Pilonidal sinus

Question 1

What is pilonidal sinus?

Answer 1

Pilonidal sinus = cavity left behind from an abscess

Asymptomatic = small pit or non-tender lump in the intergluteal/natal cleft, which may have an emergent hair

Acute = Painful, tender lump in the natal cleft, which may be fluctuant and have purulent discharge

Discharging = chronic pain, discharge of pus from the lateral opening and recurrent abscess formation and infection

Question 2

What is the aetiology of pilonidal sinus

Answer 2

Pilonodial disease occurs when gravity pulls the buttocks and cleft from the bone so strongly that the skin stretches, at the bottom of the follicle (where it is thinnest), causing it to break down and an abscess occurs

Question 3

What are the risk factors of pilonidal sinus?

Answer 3

• Hairy body
• Overweight
• Deep gluteal cleft
• Poor hygiene
• Long hours being seated
• Repeated chafing
• FH

Question 4

What is the epidemiology of pilonidal sinus?

Answer 4

• 2x more common in men
• Occurs in 0.7% of the population
• Usually occurs between ages 15-30

Question 5

What are the symptoms of pilonidal sinus?

Answer 5

Acute
o Pain
o Tenderness whilst doing sit ups

Chronic
o Incontinence
o Occasional bleeding/discharge

Question 6

What are the signs of pilonidal sinus?

Answer 6

Tender palpable nodule

Openings in the pilonidal midline
o Generally, at the level of the coccyx/sacrum
o Often discharge
o Hair debris common

Infected sinus typically is accompanied by one or several pits

Question 7

What are the investigations for pilonidal sinus?

Answer 7

• History

* Examination

Question 8

What is the management for pilonidal sinus?

Answer 8

IF asymptomatic
o Watch and wait
o Meticulous perianal hygiene - Regular baths or showers

IF acute
o Urgent same day incision and drainage
o Analgesia - Paracetamol first, NSAIDs
o Long term measures to reduce recurrence- Meticulous perianal hygiene, Buttock hair removal

IF discharging
o Surgery - Pit-picking method, Wide excision
o Analgesia - Paracetamol, NSAIDs
o ABs (if cellulitis)- Flucloxacillin 500mg 4x daily for 7 days

Question 9

What are the possible complications of pilonidal sinus?

Answer 9

Recurrence

Surgical complications
o	Recurrence
o	Wound dehiscence
o	Infection
o	Delayed healing
o	Pain

Question 10

What is the prognosis of pilonidal sinus?

Answer 10

Very few patients affected persistently beyond age 40