Sinus, fistula, cyst

for MBBS student

1. Dr. Md. Majedul Islam FCPS(Surgery) Assistatnt Professor, JIMCH Sinus, Fistula, Cyst

2. Sinus Def: Blind ending tract lined by granulation tissue leading from an epithelial surface down into the tissues .

3. Causes Congenital Preauricular sinus Umbilical Urachal Coccygeal Sacral Acquired TB sinus Pilonidal sinus Median mental sinus Actinomycosis

4. Fistula Def: A fistula is an abnormal communication between two epithelium lined surfaces. This communication or tract may be lined by granulation tissue

5. Types/Classification Congenital : Branchial Tracheoesophageal Umbilical Acquired : Fistula in ano Enterocutaneous fistula Aretriovenous fistula(Traumatic/Iatrogenic for HD)

6. Causes for persistence of sinus (or) fistula Presence of a foreign body. e.g., suture material Presence of necrotic tissue e.g.,sequestrum Epithelialisation (or) endothelisation of the track. e.g., AVF Malignancy. Irradiation Malnutrition Specific causes. e.g., DM,TB , actinomycosis Ischemia Drugs . e.g., steroids Lack of rest Insufficient (or) non-dependent drainage. e.g., TB sinus Distal obstruction. e.g., faecal (or) biliary fistula Persistent drainage like urine/ faeces /CSF

7. C/F: Usually asymptomatic, but when infected manifest as- Recurrent / persistent discharge. Pain . Constitutional symptoms  Clinical examination: Inspection: Site, number, discharge, surrounding skin Palpation: Temperature, tenderness , Discharge, Induration , Fixity lymph nodes

8. Investigation: CB- Hb , TLC, DLC, ESR . Discharge for C/S , AFB, cytology, Gram staining. X-RAY of the part to rule out OM, foreign body. MRI ( fistulogram ) BIOPSY from edge of sinus Sinusogram / Fistulogram

9. Treatment principle Antibiotics Adequate rest Adequate excision Adequate drainage.