Pilonidal Sinus Disease Flashcards
What is pilonidal sinus disease?
Disease of the inter-gluteal region.
There is formation of a sinus in the clef of the buttocks which most commonly affects males aged 16-30ys.
Pathophysiology
Starting from a hair follicle in the intergluteal cleft that become infeceted or inflamed.
The inflammation leads to obstruction of the opening of the follicle.
This leads to an inwards growth forming a pit.
A foreign body-type reaction leads to formation of a cavity.
Risk factors
Caucasian males
Coarse dark body hair
Sitting for prolonged periods like lorry driver or office workers
Increased sweating
Buttock friction
Obesity
Poor hygeine
Local trauma
Clinical features
Discharging and intermittently painful sinus in the sacrococcygeal region.
A pilonidal abscess can also form
Examination findings
Fluctuant and tender mass
Might have systemic features
What is the main distinguishing features compared to perianal fistula?
Does not communicate with the naal canal.
A rigid sigmoidoscopy or MRI can be done if there is uncertainty, not internal opening of a tract should be found.
Conservative management
Shaving the affected region and plucking the sinus free of any hair that is embedded.
Any accessible sinuses can be washed out with water to prevent infection.
Surgical management
Abx shoulde be used in septic episodes, but any abscess will need surgical drainage.
Incision and drainage with washout is needed in abscess formation.
What is the treatment in chronic disease?
Removal of the pilonidal sinus tract
Two main surgical methods
Excision of tract and laying the wound open to heal by secondary intention. (low rate of recurrence but can longer to heal)
Excision of tract + primary closure of the wound (higher rates of recurrence and paitent might need reconstructive surgery due to tissue loss from operation)
