Anal fistula and pilonidal sinus disease coexisting simultaneously: An audit in a cohort of 1284 patients

Fistula-in-ano and pilonidal disease are not known to occur together. In a retrospective study, all patients having fistula-pilonidal disease coexisting simultaneously were included. Out of 1284 patients, 933 were operated (fistula-in-ano, 849; pilonidal disease, 77; and coexisting fistula-pilonidal, 7). A total of 351 patients did not undergo any surgery (two patients had coexisting fistula-pilonidal). Thus, a total of nine patients having coexisting fistula-pilonidal sinus were included in the study (mean age 35.8 ± 19.9 years, M/F 7/2). pIn 6/9 patients, the pilonidal tract was communicating with fistula-in-ano, and in 3/9 patients, they were not communicating/connected. The connection could be established preoperatively with the help of MRI. In all patients with communicating fistula-pilonidal sinus (n=6), the fistula was posterior. 6/9 patients had recurrent fistula and all (9/9) had multiple tracts. The fistula was high and complex in 8/9 patients (grade IV-7, grade V-1). 4/9 patients tested positive for tuberculosis while one patient was suffering from hidradenitis suppurativa. The latter improved on medical treatment. One patient did not agree for surgery and seven were operated. The disease healed in four patients, the disease did not heal in one patient, and two patients were in the convalescent stage. Anal fistula and pilonidal disease can coexist in a same patient and can even be connected. Such diseases are more complex and have a higher incidence of associated diseases like tuberculosis. Magnetic resonance imaging plays a pivotal role in diagnosis. If the connection is missed, the disease treatment becomes difficult.