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Pilonidal sinus of the perianal region: Difficult to diagnose
1University of Health Science, Istanbul Haydarpasa Education and Research Hospital, Department of General Surgery Istanbul, Turkey.
Background:
Pilonidal sinus usually arises in the area of natal cleft in young men. Hair accumulation in the wound in the perianal region is very rare. Although pelvic magnetic resonance imaging (MRI) is used in the differential diagnosis of perianal region diseases, it is not possible to diagnose perianal pilonidal sinus by MRI.
Case:
A 24-year-old male patient presented with the complaint of swelling and itching in the anus for several months. On physical examination, the area giving endure and fluctuation was detected in the perianal region. An area of 2 × 2 cm hyperintense in T2 was seen in pelvic MRI. In the surgical exploration, collection of hair was seen at 7 o'clock at perianal region with pus discharge. After the cavity was cleaned, crystallized phenol was applied to the area and the wound was left to secondary healing. Granulation was observed after 4 weeks.
Conclusion:
Perianal pilonidal sinus is very rare in the literature and is often confused with other perianal diseases such as perianal abscess or anal fistula. In this respect, when examining perianal diseases, especially in young men, perianal pilonidal sinus should be kept in mind in the differential diagnosis.
Insights
Perianal pilonidal sinus, a rare condition involving hair in the anal region, can be mistaken for other perianal diseases. Early consideration in young men is crucial for accurate diagnosis and treatment.
Area of Science:
- Proctology
- Surgical Pathology
Background:
- Pilonidal sinus typically affects the natal cleft in young males.
- Perianal hair accumulation is an exceptionally rare presentation.
- Pelvic MRI is insufficient for diagnosing perianal pilonidal sinus.
Observation:
- A 24-year-old male presented with chronic anal swelling and itching.
- Physical examination revealed a fluctuant perianal area.
- Pelvic MRI showed a 2x2 cm T2 hyperintense region.
Findings:
- Surgical exploration identified a perianal hair collection with pus at the 7 o'clock position.
- Treatment involved cavity cleaning and secondary wound healing with crystallized phenol.
- Successful granulation was observed within 4 weeks post-treatment.
Implications:
- Perianal pilonidal sinus is a rare differential diagnosis for perianal abscess or anal fistula.
- Increased awareness is needed for timely diagnosis in young men presenting with perianal conditions.
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