Jeep driver’s disease of the penis: ultrasound-guided management of a penile pilonidal sinus: a case report and review of the literature

Pilonidal sinus is a chronic inflammatory condition resulting from the subcutaneous trapping of hair, most commonly in the sacrococcygeal region. Penile involvement is exceptionally rare and, because the presentation is non-specific and it is frequently mistaken for a penile abscess or for malignancy. Diagnosis in the published literature has been almost invariably retrospective, following excision and histopathological examination. We report a 25-year-old uncircumcised, morbidly obese man who presented with pain and swelling over the left preputial area of five to seven days duration, resistant to oral antibiotics and analgesics, with pus discharging through a small sinus at the coronal sulcus. Ultrasonography demonstrated a subcutaneous collection containing a linear echogenic focus consistent with a hair shaft. He underwent emergency drainage of pus, division of synechiae, removal of the hair shaft from the sinus tract under intraoperative sonographic control and a dorsal slit of the preputial skin; a confirmatory scan before closure excluded residual collection or retained foreign material. His postoperative course was complicated by a fixed drug reaction, which settled on withdrawal of the offending drugs and a short course of steroids, and prepucioplasty was planned electively in view of recurrent balanoposthitis. A review identified 34 previously reported patients, which has been summarized. The causative hair can be demonstrated on imaging and its clearance was confirmed intraoperatively; thus the diagnosis may be established before histopathology and the extent of surgery required may be reduced.