Estimation Of Pathomorphological Peculiarities Of Perivulnar Tissue After Ultrasonic Curettage Of Pilonidal Cysts Of Sacro-Coccygeal Region

The results of morphological research of operative wound’s tissue after ultrasonic curettage of acute pilonidal abscess are presented in the article. 13 patients were treated using the offered method, and of these, 11 patients underwent morphological research of the wound’s walls. Areas of the mucoid degeneration of the fibrous connective tissue and fragments of coagulation necrosis were identified, as a result of low-frequency ultrasound. The morphological substrates of recurrence pilonidal sinus, such as stratified squamous epithelium and hair follicles, were not found in any preparation, The offered method of treatment allows for ambulatory primary radical treatment in theacute stage of pilonidal illness. The offered method of ultrasonic curettage of the pilonidal sinus requires more scientific research and monitoring.

EP.FRI.469 A closed-loop audit regarding the practice of sending Pus Swab for culture and sensitivity in Pilonidal abscess drainage

Aim The purpose of this study was to determine the role of Microbiological swabs taken during an Incision and drainage for Pilonidal abscess in patient management. Method We performed a closed-loop audit to determine the role of pus swabs in the management of pilonidal abscess. Parameters like patient demographics, date of surgery, whether or not pus sent for microbiological examination, the subsequent report, the time required for sample processing, antibiotics prescribed were considered. The data was collated, analysed, and presented at clinical governance. We then implemented in our treatment protocol to stop the practice. This data was again, prospectively collected to complete the audit cycle. Result A total of 250 patient were included in this study. Prior to the change of practice, swabs were sent in 77% of the cases. The average reporting time of the swabs was 4.3 days and 92% of the patients were discharged on antibiotics. After conducting multiple teaching sessions for the trainees and educating the theatre staff, the percentage of swabs sent was brought down to 58%. Conclusion The pilonidal abscess has high infection and recurrence rate. Hence, the management involves incision, drainage and antibiotics cover in most cases. In our study, the swab results did not alter patients management. Most of them were treated with Co-Amoxiclav and some required additional Metronidazole. Hence, we suggested the routine use of swab for culture in pilonidal abscess cases are unwarranted. This change of practice resulted in huge cost savings at our hospital.

Pilonidal disease

Pilonidal disease presents with a range of signs and symptoms: asymptomatic pits in the natal cleft, acute abscesses, chronic disease with persistent, discharging sinuses, or recurrent disease following previous attempts at treatment. It primarily affects the sacrococcygeal region and is a disease of young adults, generally male, and leads to pain, disability, and time lost from work. The treatment for an acute pilonidal abscess is widely accepted to be incision and drainage with the incision placed out of the natal cleft. The treatment of chronic and recurrent disease is contentious with excision and then either healing by secondary intention, primary closure, or flap closure all being suggested alongside other less aggressive approaches aimed at conserving tissue. Currently none of these treatments is ideal, although primary closure in the midline has been shown to be inferior and should not be performed.

Extraosseous Ewing sarcoma presenting as recurrent intergluteal pilonidal disease

Background Pilonidal disease classically presents as an abscess or soft tissue swelling which classically occurs in the intergluteal cleft, just above the anus. Risk factors for this disease include obesity, prolonged sitting, and abundance of gluteal hair. Treatment options are extensive but most often include incision and drainage with antibiotic treatment. Presentation of recurrent intergluteal pilonidal disease in a young, active female would then be unusual. We present a case of a 17-year-old female presenting with what appeared to be intergluteal pilonidal disease. Definitive excision with histopathology revealed a diagnosis of extraosseous Ewing sarcoma. Case presentation An otherwise healthy and active 17-year-old female presented to our Pediatric Oncology clinic with a 2-month history of recurrent painful soft tissue swelling of the intergluteal cleft. At that time, she had been diagnosed with pilonidal abscess and had already undergone three incision and drainage procedures. A definitive excision with pathology was performed within weeks of her initial presentation. Immunohistochemical evaluation confirmed a diagnosis of extraosseous Ewing sarcoma. Conclusion This unusual case underlies the importance of considering a broad differential when evaluating potential pilonidal abscess in a patient who otherwise has no risk factors. Additionally, definitive excision with pathology is critical in a patient with unusually recurrent disease as this can be crucial in the identification of an alternative, and potentially devastating, diagnosis.

A study on the effectivness of Guggulu based Karaveera Ksharasutra in comparison with Apamarga Ksharasutra in the management of Shalyaja Nadivrana w.s.r. to Pilonidal Sinus

Shalyaja Nadivrana is of Agantuja Vranabedha. Nidana Panchaka is described in Sushruta Samhita Nidhana and Chikitsa Sthana. Presence of “Shalya” is hindering factor for healing. Management of Nadivrana includes Ksharasutra ligation. Pilonidal sinus is acquired sinus occurring in young hirsute men’s commonly seen at intergluteal cleft caused by hair penetrating the skin resulting in Pilonidal abscess which gradually forms into sinus with presence of “Hair” leading to wound discharge. It is one of the troublesome diseases which doesn’t respond to medical management till hair is evacuated. The current surgical procedures adopted have surgical risk and recurrence as well. Guggulu and Karaveera is abundantly available and can be preserved easily for long time. Hence can be used as substitute to the standard Ksharasutra. The present study “A study on the effectiveness of Guggulu based Karaveera Ksharasutra in comparison with Apamarga Ksharasutra in the management of Shalyaja Nadivrana w.s.r. to Pilonidal Sinus”was conducted in SJIIM hospital Bengaluru with 40 patients randomly allotted into 2 groups namely - Group A and Group B. Assessment was done based on subjective parameters like (pain, discharge) and objective parameters like (length of tract, tenderness). Observation was done before treatment and on every 7th day till tract is completely cut and healed. Assessment of Pain, discharge, length of tract and tenderness in Group-A showed 100%, 100%, 100% and 100% improvement and in Group-B showed 97.92%, 100%, 100% and 100% respectively. UCT in Group-A is 6.58% and Group-B is 9.15%. Overall results of group A and B is 100% and 99.5% respectively. Statistical analysis revealed that the effectiveness of Guggulu based Karaveera Ksharasutra in Shalyaja Nadivrana is as effective as Apamarga Ksharasutra w.s.r. to pilonidal sinus.

An unexpected diagnosis of paediatric subcutaneous sacrococcygeal extraspinal ependymoma: lessons learnt and review of the literature

This case describes a 9-year-old male who presented to general surgical clinic with a 3-year history of persistent natal cleft swelling, previously unsuccessfully treated as a pilonidal abscess in the community with multiple courses of antibiotics. In clinic, a 50 × 30-mm soft tissue swelling was found in the natal cleft and a clinical diagnosis of a pilonidal cyst was made. A cream-coloured solid mass measuring 50 × 35 × 30 mm was subsequently excised under general anaesthetic, with specialist histology and immunostaining confirming an unexpected diagnosis of a subcutaneous extraspinal myxopapillary ependymoma, a tumour usually found in the neuraxis. Given the atypical anatomical site of the tumour, the case presented a unique management challenge. Ultimately, the patient underwent a re-operation after specialist multi-disciplinary discussion and is currently disease free at 18 months post-surgery. The authors wish to contribute their experiences of managing this rare extraspinal ependymoma to the few existing reports in the literature.