Pilonidal sinus Flashcards
Define pilonidal sinus
obstruction of natal har follicles roughly 6cm above anus
outline the aetiology of pilonidal sinus?
Ingrowing of hairs excites a foreign body inflammatory reaction and may cause secondary tracks to open laterally +/- abscesses with foul-smelling discharge.
Intermittent negative pressure will draw in more hair and perpetuate the cycle
what are the risk factors of pilonidal sinus?
Hirsutism
Spending a long time sitting down
Occupational (e.g. hairdressers may develop interdigital pilonidal sinus)
FHx
summarise the epidemiology of pilonidal sinus?
COMMON
Affects 0.7% of young adults
Male ages 16 – 40 years
Obese Caucasians and those from Asia, Middle East and Mediterraneanat high risk
what are the presenting symptoms of pilonidal sinus ?
Painful natal cleft
Discharging swelling
Often recurrent
what are the sign of pilonidal sinus on physical examination?
Midline openings or pits between the buttocks
Hairsmay protrude from the swelling
If infection or abscess, the swelling will become tender
It may be fluctuant and discharge pus or blood-stained fluid on compression
Skin Maceration due to chronic irritation caused by the sinus discharge
what are the appropriate investigation for pilonidal sinus?
none- diagnosis is clinical
Bloods - to check for signs of infection
- Raised WCC
- Fasting glucose (diabetics are at risk)
what are the complications of pilonidal sinus?
Pain
Infection
Abscess –> typically occurs in the natal of hairy individuals
Recurrence
summarise the prognosis of patients with pilonidal sinus?
Good with drainage
Shaving will cure in most cases
Usually resolves by the age of 40
outline a management plan for pilonidal sinus>
Consider pre-op antibiotics(e.g. amoxicillin + clavulanate)
Prevention
- Good hygiene
- Shaving
Primary disease
- Without abscess: sinus excision or primary off-midline closure (on either side of natal cleft)
- With abscess: drainage + incision
