Pilonidal sinus

Question 1

define a pilonidal sinus?

Answer 1

an abnormal epithelium-lined tract filled with hair that opens onto the skin surface, most commonly in the natal cleft

Question 2

what are the risk factors of a pilonidal sinus?

Answer 2

• Caused by shed or sheared hairs penetrating the skin and inciting and inflammatory reaction and sinus development
• Intermittent negative pressure will draw in more hair and perpetuate the cycle
• Eventually an abscess forms

Question 3

risk factors of pilonidal sinuses?

Answer 3

o Hirsutism
o Spending a long time sitting down
o Occupational e.g. hairdressers may develop interdigital pilonidal sinus)

Question 4

epidemiology of pilonidal sinus?

Answer 4

• Affects 0.7% of young adults
• More common in men after puberty
• More common in Caucasians

Question 5

presenting symptoms of pilonidal sinuses?

Answer 5

• Painful natal cleft
• Discharging swelling
• Can present with an abscess
• Cycles of being asymptomatic and periods of pain and discharge

Question 6

signs of pilonidal sinus on physical examination?

Answer 6

• Midline openings or pits between the buttocks
• Hairs may 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

Question 7

investigations for pilonidal sinuses?

Answer 7

• NONE needed
• Bloods - to check for signs of infection
o Raised WCC
o Fasting glucose (diabetics are at risk)

Question 8

management for abscess?

Answer 8

o antibiotics Incision and drainage

Question 9

management for pilonidal sinuses?

Answer 9

• Bascom procedure
o Excision of pits and destruction of the underlying cavity.
• Karydakis procedure
o Involves wide excision of the natal cleft

Question 10

how to prevent pilonidal sinuses?

Answer 10

o Good hygiene

o Shaving

Question 11

complications of pilonidal sinuses?

Answer 11

• Pain
• Infection
• Abscess
• Recurrence

Question 12

what is the prognosis for patients with a pilonidal sinus?

Answer 12

• Good with drainage
• Shaving will cure in most cases
• Usually resolves by the age of 40