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Born with pilonidal sinus. pus discharge. Surgery recommended. Not able to do surgery since hole is not seen. Why?

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General & Family Physician
Practicing since : 1968
Answered : 298 Questions
Hi. I was born with a pilonidal sinus. I am female, 52 years old and it only started to bother me 18 years ago. 3 - 4 times a year it oozes smelly clear/white pus, but no lumps. I went to see GP and was referred to surgeon. It was confirmed as a pilonidal sinus but was closed at the time. After giving him my symptoms he recommended surgery. I was admitted to hospital and put under general anesthetic. When I woke up I was told that he was unable to operate as he could not find a hole. He has told me to come back and see him next time it oozes. I am completely puzzled. If there is no hole, how is the oozing liquid getting through? Could it be seeping through the actual skin? If there is no hole, it this not then a pilonidal sinus? Could it be something else that looks like a pilonidal sinus? Please help me to try and understand what is going on. Many thanks
Posted Wed, 2 May 2012 in Ear, Nose and Throat Problems
Answered by Dr. Andrew Rynne MD 4 hours later

Hi there XXXXXXX Thank you for posting your question with XXXXXXX I will do my best to help you.

A pilonidal sinus is just like something that you in Iceland should be very familiar with. It is just lie, a under ice quizzer. While it is erupting you can easily see where it is coming from. However, while it is quiescent or dormant, there is nothing to be seen.

I am not a surgeon but I do know that the surgical management of pilonidal cyst does not necessarily depend on being able to identify the source of potential eruption. A more traditional approach is wedge resection of the whole area and allowing this to heal up through granulation.

Another approach of course is to do nothing other than antibiotics when you think an eruption is eminent. This and all the life-style changes that you can think of, with great emphasis on stress reduction.

I hope that I have answered your questions fully and been of some help. If you have anymore questions please contact me again anytime.

Dr Andrew Rynne.

Above answer was peer-reviewed by
Follow-up: Born with pilonidal sinus. pus discharge. Surgery recommended. Not able to do surgery since hole is not seen. Why? 15 hours later
Hello Dr Rynne. Thank you so much for the info. I now understand a little more about the condition. The way in which you have described it to me makes perfect sense, although I'm left doubting the surgeon who insisted that there should still be a hole while being in a dormant situation. If this was his view he should never have arranged to operate as the site was closed when he examined me, and obviously there was no hole to be seen. Shame on him for taking me all the way to the operating table without better knowledge.
I do have one further question out of curiosity though. Is it the case that each time it erupts it can come through at different sites within the area, or will it always at the same site?
I look forward to hearing from you.
Many thanks
Answered by Dr. Andrew Rynne MD 1 hour later
Hi there again XXXXXXX Thanks for your follow up question.

Pilonidal sinus is a strange condition and can take differing forms. Classically it forms several fistula or potential escape channels to the surface. Therefore, to answer your question, a classical pilonidal cyst can erupt in different places during ensuing attacks.

However, they sometimes choose a "preferred route" to which they remane faithful.

Hope this answers your query. Let me know if you have any more queries. And if I have answered all your queries, please close this discussion.

Wish you good health.

Andrew Rynne.
Above answer was peer-reviewed by
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