lec 3 rd year sinus.pptx

sinus & fistula

1. Sinus & Fistula Dr. Md. Nazmus Sakib Junior Consultant Department of Surgery [email protected]

2. Review of the previous class Abscess Boil Carbuncle Furuncle Erysipelas

3. Sinus Sinus is a blind tract lines by granulation tissue that connect a cavity with an epithelial surface.

4. Classification

5. Congenital sinus

6. Acquired sinus

7. Physiological sinus

8. Pathological sinus

9. Clinical feature Usually asymptomatic but when infected may manifest as P ersistent discharge (serous/purulent) Pain On palpation – indurated

10. Investigation For assessment of sinus tract – contrast imaging ( sinogram )

11. Investigation ( cont …) For assessment of associated factor Complete blood count Random blood sugar Discharge for AFB, C/S, gram staining, cytology MRI

12. Treatment Adequate excision Adequate drainage Antibiotic Rest After excision, sinus tract should be sent for histopathological examination.

13. Fistula Latin fistula means tube or pipe . Fistula is an abnormal communication between two epithelial surface lined by healthy or unhealthy granulation tissue.

14. Classification

15. Clinical feature Persistent discharge Character of discharge depends on underlying organ Pain Induration

16. Investigation Contrast imaging (contrast X-ray/ contrast CT)

17. Investigation ( Cont …) MRI is the gold standard investigation . Other supporting investigation to evaluate the underlying pathology.

18. Treatment Complete excision of fistulous tract and histological examination. Treatment of underlying cause.

19. Causes of persistent sinus or fistula Presence of foreign body-suture material Presence of necrotic tissue underneath- sequestrum Insufficient drainage-TB sinus Distal obstruction- feacal or biliary fistula Persistent drainage like urine/ faeces Lack of rest Epithelialization of the tract

20. Causes of persistent sinus or fistula ( Cont …) Irradiation Malignancy Malnutrition Ischemia or poor vascularity Drug