Pilonidal Sinus

Question 1

Define pilonidal sinus

Answer 1

A pilonidal sinus (Latin for ‘nest of hair’) is an abnormal epithelium-lined tract filled with hair that opens to the skin surface, most commonly in the natal cleft (the deep groove which runs between the two buttocks) ~ 6 cm above the anus

Question 2

What are the causes/risk factors of pilonidul sinuses?

Answer 2

• Hirsute individuals (hairy)
• Asian and Middle Eastern
• Males
• Obesity
• Diabetes
• Long time spent sitting down.
• Barbers (interdigital pilonidal sinus)

Question 3

What are the symptoms of perinodal sinuses?

Answer 3

• Presence of risk factors
• Painful natal cleft
• Discharge, often foul smelling

Question 4

What are the signs of perinodal sinuses?

Answer 4

• Presence of midline openings or pits seen between the buttocks, from which hairs may protrude.
• If associated infection or abscess, a tender swelling develops; fluctuant, discharges pus or bloodstained fluid.
• Secondary openings may be seen on either side of the midline

Question 5

What investigations are carried out for perinodal sinuses?

Answer 5

• Diagnosis can be made on clinical features.

* FBC may show leucocytosis, particularly if an abscess forms

Question 6

What is the management of perinodal sinuses?

Answer 6

• Conservative: Good hygiene of the area and shaving is important to prevent recurrence.
• Surgical: Excision of the sinus tract ±primary closure. Consider Pre-op antibiotics. Complex tracks can be laid open and packed individually. Skin flaps can be used to cover the defect

Question 7

What are the complications of perinodal sinuses?

Answer 7

• Pain
• Abscesses
• Infection
• Recurrence