Pilonidal sinus is a condition where one or more non-infected openings form in the midline of the natal cleft overlying the coccyx. Hair can become trapped in these openings, leading to infection or abscess. It is more common in males after puberty, and in individuals with dark hair. Symptoms include intermittent discharge, pain, swelling, and abscess formation. Diagnosis is usually clinical but MRI may help with extensive cases. Treatment involves cleaning and removing hair from openings, antibiotics for infection, and surgery to excise sinus openings and flatten the natal cleft to prevent further hair implantation and recurrence.

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’.

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

5. • 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 features:
• 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.

6. • 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.

7. TREATMENT:
Medical/non-surgical:
• Simple 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).

8. THANK
YOU