Pilonidal sinuses result from skin and subcutaneous tissue infections, typically occurring at or near the upper part of the natal cleft of the buttocks. As such is it often also termed an intergluteal pilonidal sinus. While it can also occur at other sites (see location section), this article is focused on intergluteal pilonidal sinuses.
While it can potentially occur at any age, it is much less common in children and older individuals (e.g. those older than 45). The peak age of presentation is patients in their twenties. There is an increased male predilection.
It is characterized by natal cleft suppuration and is thought to initially result from a hair follicle infection. This can then lead to the subsequent formation of a subcutaneous abscess from a persistent folliculitis. Hair can then enter the abscess cavity and provoke a foreign body tissue reaction.
While it classically occurs in the intergluteal region, it can rarely occur at other sites (e.g. interdigital pilonidal sinus 4,5).
May show sinus anatomy to a reasonable degree in superficial cases.
Allows visualization of tract anatomy also useful in assessment associated inflammation.
Contrast is injected into the cutaneous opening to delineate the extent of a sinus and its morphology. It may also identify if there are any fistulous tracts rather than merely a sinus.
History and etymology
It is thought to have been initially described by Herbert Mayo in 1833 2.
An intergluteal pilonidal sinus can be clinically difficult to differentiate from a fistula-in-ano.
- 1. Taylor SA, Halligan S, Bartram CI. Pilonidal sinus disease: MR imaging distinction from fistula in ano. Radiology. 2003;226 (3): 662-7. doi:10.1148/radiol.2263011758 - Pubmed citation
- 2. Mayo OH. Observations on injuries and diseases of the rectum London, England: Burgess & Hill, 1833; 45-46.
- 3. Mentes O, Oysul A, Harlak A et-al. Ultrasonography accurately evaluates the dimension and shape of the pilonidal sinus. Clinics (Sao Paulo). 2010;64 (3): 189-92. Free text at pubmed - Pubmed citation
- 4. Imanishi H, Tsuruta D, Nomura N et-al. Clinical usefulness of ultrasonography in interdigital pilonidal sinus. J Cutan Med Surg. 2012;16 (3): 194-6. Pubmed citation
- 5. Adams CI, Petrie PW, Hooper G. Interdigital pilonidal sinus in the hand. J Hand Surg Br. 2001;26 (1): 53-5. doi:10.1054/jhsb.2000.0494 - Pubmed citation
- 6. Imaging of Perianal Inflammatory Diseases. Springer. ISBN:8847028469. Read it at Google Books - Find it at Amazon