ABC of colorectal diseases. Pilonidal sinus.

Pilonidal disease is a common affliction of young adults that causes considerable suffering, inconvenience, and time lost from work.Treatment varies greatly and is often less than satisfactory.The rate of recurrence after surgery is purported to be as high as 50%.Pilonidal sinus with hairy natal cleft and .secondarylateral openings.What is a pilonidal sinus?*;> ; ; 0:; Y; A pilonidal sinus consists of a characteristic midline opening or series of penings in the natal cleft about 5cm from the anus.The skin enters the '.i''-,.''sinus, giving the opening a smooth edge.This primary track leads into a subcutaneous cavity which contains granulation tissue and usually a nest of ..:* .'f..i r:.i..'ĩ i,f. .hairs, which may be seen projecting through the skin opening.Many patients have secondary lateral openings 2-5 cm above the midline pit.The skin opening and superficial portion of the track are lined with squamous 0e$ R 100 cell epithelium, but the deep cavity and its extensions are not.Non-infected pilonidal sinus. Pathogenesis.W ~~~~~~~~~af X _y ^h_A 8a 3A ~~~~~~~~~~~Pilonidal sinuses are now widely accepted to be acquired abnormalities, although theories ofai congenital origin, from postcoccygeal cells or vestigial scent glands, were once popular.Sinuses to the neural canal and dura are ~~r ~~rare; they usually present in childhood and are in the lumbar rather than ~~~~~* ~~~~~~sacral region.Pilonidal disease starts at the onset of puberty, when sex hormones start .~actingon ilosebaceous glands in the na'tal cleft.A hair follicle becomes distended with keratinand subsequently infected, leading to a folliculitis Mechanism ~~~~~~~~hv trck whicheesi pas cadlyan hspilonidal sinusestn.