Pilonidal sinus

An overview to pilonidal sinus.

1. PILONIDAL SINUS PRESENTED BY : Dr. Aresha Aziz Khan House Officer Ward# 26

2. PILONIDAL SINUS The term pilonidal sinus describes a condition found in the natal cleft overlying the coccyx, consisting of one or more, usually non-infected, midline openings, which communicate with a fibrous track lined by granulation tissue and containing hair lying loosely within the lumen . A common affliction amongst the military,it has been referred to as ‘jeep disease’.

3. Two  pilonidal sinus  that have formed in the gluteal cleft of an adult male.

4. The condition is seen much more frequently in men than women, usually after puberty and before the fourth decade of life. It is characteristically seen in dark-haired individuals. Clinical features: The primary sinus may have one or many openings, all of which are strictly in the midline between the level of the sacrococcygeal joint and the tip of the coccyx. Irritative feature s: Intermittent discharge and inflammation with pain and swelling . Acute sepsis : Acute abscess formation is common with swelling, pain, and erythema; may discharge spontaneously or may cause fistulation with sinuses appearing in the lateral buttock tissue. Chronic sepsis : Usually follows unresolved acute sepsis either after spontaneous discharge or surgical drainage.

5. Diagnosis and investigations: Ensure the patient is tested for occult diabetes mellitus. Very extensive sinus formation and fistulation may be assessed by MRI scanning of the natal cleft and buttocks.

6. TREATMENT: Medical/non-surgical : S imple cleaning out of the tracks and removal of all hair, with regular shaving of the area and strict hygiene, may be recommended. Intermittent courses of antibiotics may be required for septic episodes. Formed pilonidal abscess or collection requires surgical drainage. Recurrent sepsis usually requires surgical treatment. Surgical: Principles of surgical treatments are: Excision of all sinus openings. Obliteration of all infected or chronically inflamed tissue. Obliteration of the natal cleft by flattening (thought to be most important in the prevention of recurrence by reducing the risk of further hair implantation).

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