Abstract
Pilonidal Sinus typically presents as an abscess, purulent discharge, or pits around midgluteal cleft.. In rare cases sinuses progress anteriorly mimicking Fistulas in Ano. Clinicians and especially surgeons should be aware of this situation, in order to avoid reoperations and patient's discomfort and frustration. These complex cases with secondary openings may create problems in diagnosis and treatment when the secondary openings are close to the anus. In this case a single-stage surgical procedure for treatment of sacrococcygeal pilonidal disease with healing by secondary intention is described
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