Carcinoma complicating a pilonidal sinus

Summary and Conclusions Medical literature concerning neoplastic change within a pilonidal sinus is reviewed briefly and a case of epidermoid carcinoma involving a pilonidal sinus is presented. Diagnosis, pathology and treatment are discussed. Epidermoid carcinoma occurs rarely in pilonidal disease and usually it is a complication of a long-standing, draining sinus. The lesion generally grows slowly, may extend locally or into the regional lymph nodes, and there may be generalized metastasis. If diagnosed early, wide excision and primary skin grafting of the invaded area may be performed, with a reasonably good chance of a desirable result. Read at the meeting of the Pennsylvania Proctologic Society, Philadelphia, Pennsylvania, March 7, 1962.     

Osteomyelitis of both clavicles as a complication of subclavian venipuncture

Complications of subclavian vein catheterization are common and include pneumothorax, hemothorax, and sepsis. Osteomyelitis is a rare complication. The present report describes a patient with osteomyelitis of both clavicles due to subclavian vein venipuncture, in whom fever and chills were absent and the sole clinical finding was local pain and tenderness in the involved area.     

Sacrococcygeal pilonidal sinus

Summary Fifty-three patients treated by surgery for pilonidal sinuses in the sacrococcygeal area during a 2 1/2-year period at The Mount Sinai Hospital of Cleveland were studied. A fourth of the patients were first seen because of an acute episode of infection, and the other patients had chronic lesions. Surgery on an elective basis consisted of 1) excision and primary closure; 2) excision with partial closure of the wound; or 3) marsupialization. Fifty of the 53 patients were followed up for two to three years; the shortest follow-up period was six months. The overall recurrence rate in this group was 6 per cent. It appears that marsupialization results in a better chance for a cure and a shorter period of hospitalization.     

Treatment of pilonidal sinus disease using fibrin glue as a sealant

Abstract. Background Complete excision is the preferred treatment for pilonidal sinus disease. We describe a new technique of excision and tension–free primary closure of pilonidal sinus disease, combined with application of fibrin glue in order to obliterate the dead space and to promote wound healing.Methods A curved incision of the carried out, 2–3 cm lateral to the opening of the sinus, done under general or spinal anesthesia, and a thick flap was created by undercutting the medial edge and advancing it across the midline. The sinus was completely excised with all of its extensions. The flap was then sutured back to its original place by several interrupted monofilament mattress sutures. Then, 2–4 ml of fibrin glue was injected through the original pilonidal sinus opening to the sinus bed in order to obliterate the dead space.Results Thirty patients with pilonidal sinus disease were treated by this technique. In four patients, there was a temporary purulent discharge through the opening of the sinus, and there were no other complications. The mean period for returning to daily activities and to work for patients was 11 days (SD=6 days). No infection or recurrent disease was noticed during the follow–up period (23±3 months).Conclusions Complete excision with tensionfree closure with fibrin glue application may be a useful technique for the treatment of pilonidal sinus disease.     

Epidermoid carcinoma arising in a pilonidal sinus

Summary and Conclusions The seventeenth case of epidermoid carcinoma arising in a pilonidal sinus is presented. Treatment and results of reported cases are reviewed. For the sake of completeness, four additional cases of unspecified types of pilonidal cancer are included. A review of all reported cases indicates that: 1) Distant metastasis occurs with about the same frequency as with epidermoid carcinoma arising in antecedent benign lesions elsewhere in the body; 2) Local treatment should consist of wide surgical removal. Irradiation by x-ray is helpful in controlling nonresectable disease; and 3) The inguinal lymph nodes should be the object of careful clinical evaluation in every patient and probably should be biopsied in all cases. The presence of positive nodes is an indication for radical groin dissection unless distant, noncurable metastasis can be demonstrated. Read at the meeting of the New England Proctologic Society, Hartford, Connecticut, April 3, 1965.     

The etiology of pilonidal sinus

Conclusions The gross and microscopic pathologic findings in our 354 patients overwhelmingly favor the theory of acquired origin in most patients with pilonidal sinus. The facts appear to show that the reason there has been so much debate over whether pilonidal disease is congenital or acquired in origin is because there are two different types of the disease. A new classification of pilonidal disease based on etiology is proposed as a result of this study. In this classification the disease is divided into two groups: (1) congenital, and (2) acquired. These two types are further subdivided; the congenital into the neurogenic and ectodermal, and the acquired into the post-traumatic and postsurgical. Neurogenic and ectodermal pilonidal sinuses are relatively uncommon, probably less than 10 per cent of the total, whereas the acquired variety of post-traumatic and postsurgical lesions constitute 90 per cent of the cases. Read at the meeting of the American Proctologic Society, Pittsburgh, Pennsylvania, June 21 to 24, 1961. Abridgment of thesis submitted by Dr. Franckowiak to the Faculty of the Graduate School of the University of Minnesota in partial fulfillment of the requirements for the degree of Master of Science in Surgery.     

Endoscopic pilonidal sinus treatment vs. laser-assisted endoscopic pilonidal sinus treatment: short-term results from a retrospective case-matched study

Techniques in Coloproctology - The aim of this study was to investigate whether the addition of laser to the endoscopic pilonidal sinus treatment (EPSIT), laser-assisted EPSIT (LEPSIT) has an...     

Negative pressure-assisted endoscopic pilonidal sinus treatment

Techniques in Coloproctology - Endoscopic pilonidal sinus treatment (EPSiT) is a novel minimally invasive option for the treatment of pilonidal sinus disease (PSD). To optimise the postoperative...     

Time and rate of sinus formation in pilonidal sinus disease

Background and aims To elicit mechanisms and timing of sinus development, the role of age at onset of symptoms, symptomatic disease duration, and consecutive number of sinuses were investigated. Materials and methods Analysis of 1,962 medical records of patients admitted for primary surgical pilonidal sinus treatment. Results Sinus number ranged from 1 to 16 (median 2), with chronic pilonidal disease showing more sinuses than acute disease (mean 2.6 vs 2.1 sinuses; p < 0.0001; Kolmogorov–Smirnov). Disease duration in chronic pilonidal disease was not linked to sinus formation (p = 0.98; Spearman). In acute pilonidal disease, duration was linked to the development of six sinuses per 1,000 symptomatic disease years (p = 0.0001; Spearman). A larger sinus number correlated with earlier onset of symptoms (p = 0.009; Spearman). Conclusion Long-standing chronic disease does not produce sinus per se. As sinus does not substantially arise during the course of symptomatic disease, there must be a time before the start of symptomatic disease when the sinus originates. These findings suggest that sinus can only be acquired up to a certain age, even if occupational exposure continues.     

Surgery for asymptomatic pilonidal sinus disease

INTRODUCTION: Asymptomatic pilonidal sinus disease (PSD) discovered incidentally is regarded as a precursor of symptomatic disease, which is characterized by intradermal hair eliciting an inflammatory reaction. We aimed to investigate whether asymptomatic PSD already shows inflammation, though clinically inapparent, or represents a 'virgin' sinus. MATERIALS AND METHODS: One thousand seven hundred and thirty-one medical records of patients presenting with primary PSD, which underwent surgery, were analysed to identify patients with surgically resected incidental PSD. RESULTS: Acute purulent pilonidal disease was seen in 514 of 1,731, whereas chronic fistulating pilonidal disease was the most common diagnosis group with 1,019 of 1,731 (58.9%). One hundred and forty-three of 1,731 (8.3%) patients had a previous chronic remitting pilonidal sinus. A total of 55 (3.2%) patients with clinically asymptomatic PSD were identified. Histological workup documented hair in 64.6% (1,119/1,731), with comparable rates between 68% and 71% in chronic fistulating disease, chronic remitting disease and incidental PSD (p = 0.80). Inflammation was found in 53 of 55 (96.4%) incidental PSD specimens, with two thirds (37 of 55) showing chronic inflammatory changes and one third (16 of 55) combining acute and chronic inflammation. CONCLUSION: Our findings support the idea that incidental PSD is a sub-clinically inflamed pilonidal sinus, with hair and chronic infection present. However, the data suggest that a prophylactic surgery for asymptomatic PSD provides no benefit for the patient compared to surgery in chronic PSD; thus, observational treatment is most likely sufficient for asymptomatic PSD.     

Anorectal problems: Etiology of pilonidal sinus

Diseases of the Colon &; Rectum -