Pilonidal Sinus

PILONIDAL SINUS

Q. 1

Which is not a feature of pilonidal sinus:

 A

Branching tracts are common

 B

Recurrence is uncommon

 C

Bony involvement is uncommon

 D

Seen in Drivers

Q. 1

Which is not a feature of pilonidal sinus:

 A

Branching tracts are common

 B

Recurrence is uncommon

 C

Bony involvement is uncommon

 D

Seen in Drivers

Ans. B

Explanation:

Ans. is ‘b’ i.e. Recurrence is uncommon 

“Recurrence is common, even though adequate excision of the track is carried out.” – Bailey & Love “Once an acute episode has resolved, recurrence is common”- Schwartz 9/e p1067

Pilonidal disease 

  • Pilonidal disease consists of a hair-containing abscess or chronic sinus, occurring in the intergluteal cleft.
  • It is an acquired disease

Although earlier it was thought to be a congenital disease, it is now considered to be an acquired infection of natal cleft hair follicles. The hair follicles become infected and rupture into the subcutaneous tissues to form a pilonidal abscess. Hair from surrounding skin is pulled into the abscess cavity by the friction generated by the gluteal muscles during walking.

  • More common in males

The incidence of pilonidal disease is more common in males (3:1 male: female ratio) between ages 15 & 40 with peak incidence between 16 & 20 yrs.

Pilonidal ds is more common in people with more body hair (hirsute). The ds. is almost rare in persons with less body hair.

  • Treatment of choice is surgery

Pilonidal sinus should be excised along with the secondary openings. (But only after controlling acute infection). Acute pilonidal abscesses and sinus ds can be managed by simple incision and drainage (under local anaesthesia).


Q. 2

The following statement about Pilonidal Sinus is true :

 A

More common in females

 B

Mostly congenital

 C

Prognosis after surgery is poor

 D

Treatment of choice is sugrical excision of sinus tract

Q. 2

The following statement about Pilonidal Sinus is true :

 A

More common in females

 B

Mostly congenital

 C

Prognosis after surgery is poor

 D

Treatment of choice is sugrical excision of sinus tract

Ans. D

Explanation:

Ans. is ‘d’ i.e. Treatment of choice is surgical excision of sinus tract

Pilonidal disease

  • It is an acquired disease

Althouth earlier it was thought to be a congenital disease, it is now considered to be an acquired infection of natal cleft hair follicles. The hair follicles become infected and rupture into the subcutaneous tissues to form a pilonidal abscess. Hair from surrounding skin is pulled into the abscess cavity by the friction generated by the gluteal muscles during walking.

  • More common in males
  • Treatment of choice is surgery

Pilonidal sinus should be excised along with the secondary openings. (But only after controlling acute infection). Acute pilonidal abscesses and sinus ds can be managed by simple incision and drainage (under local anaesthesia).

  • Prognosis after surgery is excellent (Ref: CSDT, I2/e p757)

Recurrent or persistent disease has been reported to be 0-15% and is likely due to inadequate excision. Inadequate postoperative hygiene with ingrowth of hair into the wound also leads to recurrance.


Q. 3

All of the following are true regarding pilonidal sinus except:     

September 2009

 A

Seen predominantly in women

 B

Occurs only in sacrococcygeal region

 C

tendency for recurrence

 D

Obesity is a risk factor

Q. 3

All of the following are true regarding pilonidal sinus except:     

September 2009

 A

Seen predominantly in women

 B

Occurs only in sacrococcygeal region

 C

tendency for recurrence

 D

Obesity is a risk factor

Ans. A

Explanation:

Ans. A: Seen predominantly in women

Pilonidal disease is described back as far as 1833, when Mayo described a hair-containing cyst located just below the coccyx. Hodge coined the term “pilonidal” from its Latin origins in 1880.

Pilonidal disease describes a spectrum of clinical presentations, ranging from asymptomatic hair-containing cysts and sinuses to large symptomatic abscesses of the sacrococcygeal region that have some tendency to recur Pilonidal disease involves loose hair and skin and perineal flora.

Risk factors for pilonidal disease include male gender, hirsute individuals, Caucasians, sitting occupations, existence of a deep natal cleft, and presence of hair within the natal cleft.

A common affliction amongst the military, it has been referred to as ‘jeep disease’.

Family history is seen in 38% of patients with pilonidal disease.

Obesity is a risk factor for recurrent disease.

Quiz In Between



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