Pilonidal sinus

Question 1

Define:

Answer 1

Obstruction of natal cleft hair follicles roughly 6cm above anus

Question 2

Aetiology:

Answer 2

Ingrowing of hairs excites a foreign body leading to an inflammatory response causing lateral secondary tracts +/- abscesses with foul smelling discharge

The negative pressure draws more hair in and worsens the cycle

Question 3

Risk factors:

Answer 3

Hirsuitism
Sitting down for a long time
Occupational - hairdressers

Question 4

Epidemiology:

Answer 4

Common

0.7% of young adults

Obese Caucasians, Asians, middle easterner and Mediterraneans

Question 5

Symptoms:

Answer 5

painful natal cleft

often recurrent

Discharge swelling

Question 6

Signs:

Answer 6

Mid-line openings or pits between he buttocks

Hairs protruding from the swelling

if infected - abscess and tender

may be fluctant + discharge pus or blood stained fluid on compression

Question 7

Investigations:

Answer 7

No investigations are needed.

Bloods - WCC for infection check and glucose for diabetes check

Question 8

management:

Answer 8

Pre-op antibiotics

Acute - incision and drainage

Chronic - excision with general anasthetic

Prevention - good hygiene and shaving

Question 9

Complications:

Answer 9

Abscesses

Infection

Pain

Recurrence

Question 10

Prognosis:

Answer 10

Good if drained

Shaving will cure most cases

resolves by 40s