Surgical Excision of a Pilonidal Sinus at the Neck Region

Zaher Mikwar,Sultan A Neazy,Hossein A Filimban,Saeed N Albukhari

doi:10.7759/cureus.13984

Abstract

Pilonidal sinus (PNS) is a clinically diagnosed condition caused by hair entrapment underneath the skin leading to a granulomatous reaction and the formation of a tract. PNS is commonly found in the sacrococcygeal area (natal cleft). However, this is a rare case presentation of a male patient with PNS located at the back of his neck region as there were only four similar conditions reported in the literature review. The patient was first managed medically as a case of hidradenitis suppurativa by the dermatology department. Later on, when the treatment failed, he was treated surgically as a case of PNS with an excellent outcome. The patient was seen at the outpatient clinic one week after surgery. The wound was healed completely and totally recovered.

Highlights

Pilonidal sinus (PNS) is a condition where the area underneath the skin is infected as a result of hair follicle entrapment leading to a granulomatous reaction and the formation of a tract that extends along the surface of the skin
Being male seems to be a major risk factor for developing PNS in Saudi Arabia as multiple studies revealed that male patients are four times more prone than females [3,5]
PNS is usually diagnosed clinically through history and physical examination. An imaging modality such as ultrasound or Magnetic resonance imaging (MRI) could be used to aid the diagnosis, especially when the PNS presents at odd locations other than the sacrococcygeal area, and to rule out other differential diagnoses which may include hidradenitis suppurativa, abscesses, inflammatory bowel disease, or fistula

Summary

Introduction

Pilonidal sinus (PNS) is a condition where the area underneath the skin is infected as a result of hair follicle entrapment leading to a granulomatous reaction and the formation of a tract that extends along the surface of the skin. The earliest description of the disease was done by Herbert Mayo in 1830 [1] Later on, it was known as “Jeep disease” as it affected many soldiers who drove jeeps on rough surfaces during the world war [1]. PNS treatment is categorized into operative, with either open or closed wound methods depending on how clear was the sinus at the time of surgery, or non-operative treatment and sometimes the combination of the two. Both are considered effective when used in the appropriate setting. Our aim is to present a rare case of a male patient who developed a neck PNS and was successfully managed operatively

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Discussion

Conclusion