sinus & fistula

1. Sinus & Fistula
Dr. Md. Nazmus Sakib
Junior Consultant
Department of Surgery
Email-sakibs23@gmail.com

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
• Congenital
• Acquired
Duration
• Physiological
• Pathological
Clinically

5. Congenital sinus

6. Acquired sinus

7. Physiological sinus

8. Pathological sinus

9. Clinical feature
• Usually asymptomatic but when infected may
manifest as
• Persistent 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.

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

15. Classification
Fistula
Congenital
Branchial fistula
Tracheo esophageal fistula
Thyroglosal fistula
Cngenital A-V fistula
Acquired
Traumatic
Inflammatory
Malignancy
iatrogenic

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

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

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

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

21. 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

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