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International Journal of Surgery Case... Mar 2024Pilonidal sinus is a condition that causes inflammation and abscesses in the sacral region and affects adolescents and young adults. The etiology of this condition...
INTRODUCTION
Pilonidal sinus is a condition that causes inflammation and abscesses in the sacral region and affects adolescents and young adults. The etiology of this condition remains controversial.
CASE PRESENTATION
A six year old boy was observed to have an orifice in the frontonasal region which contained hair. He had two previous infections which were treated with antibiotics. Magnetic Resonance Imaging showed no cranial malformations. Surgery was performed under general anesthesia and the pilonidal sinus was completely excised. At follow-up the child was in good health.
CLINICAL DISCUSSION
This case in a child with a frontonasal skin anomaly highlights that skin anomalies may be a cause of pilonidal sinus.
CONCLUSION
Skin malformations can be the underlying cause of pilonidal sinus in some cases.
PubMed: 38430899
DOI: 10.1016/j.ijscr.2024.109444 -
Diagnostics (Basel, Switzerland) May 2024Caudal regression syndrome (CRS) is a rare congenital malformation characterized by incomplete development of the lower spine and spinal cord. Its estimated incidence...
Caudal regression syndrome (CRS) is a rare congenital malformation characterized by incomplete development of the lower spine and spinal cord. Its estimated incidence ranges from 1 to 2 per 100,000 live births, leading to a spectrum of clinical presentations. Although most cases are diagnosed during childhood, only a small number of cases have been documented in adults in the medical literature. A 27-year-old woman underwent an outpatient magnetic resonance imaging (MRI) of the thoracolumbar spine due to severe lower back pain experienced for the first time. Despite congenital leg abnormalities and multiple childhood surgeries, no further investigations were conducted at that time. MRI revealed congenital anomalies consistent with CRS, including coccygeal agenesis, L5 sacralization, and spinal cord defects. The patient also had a long-standing pilonidal cyst treated conservatively, now requiring operative treatment due to an abscess. This report underscores a rare case of CRS initially misdiagnosed and mistreated over many years. It emphasizes the importance of considering less common diagnoses, especially when initial investigations yield inconclusive results. This clinical case demonstrates a highly valuable and educative radiological finding. In the literature, such cases with radiological findings in adults are still lacking.
PubMed: 38786298
DOI: 10.3390/diagnostics14101000 -
International Journal of Surgery Case... Aug 2023Fragmentation of the surgical drain is an unusual negative consequence of using a drainage system postoperatively. Even though it is rare, multiple management approaches...
BACKGROUND
Fragmentation of the surgical drain is an unusual negative consequence of using a drainage system postoperatively. Even though it is rare, multiple management approaches were documented in the literature.
CASE PRESENTATION
A 19-year-old male patient who had a history of recurrent pilonidal sinus disease that was operated on twice 4 months apart. He presented to our hospital for postoperative follow-up, during which the inserted drain was assessed. While withdrawing the drain, part of it was damaged and missed. The location of the misplaced drain was assessed by a lumbosacral region computed tomography (CT) scan. The decision was made to proceed with less invasive methods using interventional radiology techniques to avoid wide excision and incision reopening complications and prolonged healing time. A fluoroscopy procedure was performed to create three-dimensional anterolateral, frontal posterior views. Then the fragmented drain was retrieved successfully by a minimally invasive technique. The postoperative period was uneventful.
DISCUSSION
Drain fragmentation and/or dislodgement is a highly challenging event that requires highly innovative intervention. Multiple treatment options are available as open surgery techniques and endoscopic approaches.
CONCLUSION
This case highlights the potential role of fluoroscopy as an outstanding effective choice that could be carried out promptly and safely at the bedside under local anesthetic and reduce the patient's hospital stay.
PubMed: 37515851
DOI: 10.1016/j.ijscr.2023.108542 -
International Journal of Surgery Case... Jan 2024For patients with large and deep-seated recurrent complex pilonidal sinuses, the use of traditional open excision or flap reconstruction surgery may lead to high...
INTRODUCTION
For patients with large and deep-seated recurrent complex pilonidal sinuses, the use of traditional open excision or flap reconstruction surgery may lead to high surgical difficulty, significant local damage, numerous complications, slow healing, and a high risk of recurrence. This article reports a case of recurrent complex pilonidal sinus and discusses the advantages of Bascom II combined with VSD treatment involving the preservation of tissue bridges.
CASE PRESENTATION
The patient, a 31-year-old male, presented with recurrent swelling, pain, and purulent discharge from the sacrococcygeal region for over a year. Upon physical examination, extensive lumps and sinus tracts were observed in the lumbosacral tail area, with the lesion extending from L4 to the tip of the coccyx. Under general anesthesia, a segmental resection was performed, and the lumbosacral mass lesion was excised, preserving normal tissue bridges. The mature sinus tract at the upper part of the coccyx was removed, and Bascom II reconstruction surgery was performed. In the late stage at the site of lumbar sacral lesion excision, VSD was applied to promote wound healing.
DISCUSSION
The combination of Bascom II with lesion tunnel-like removal can reduce the damage, elevate gluteal cleft, and lower the recurrence rate. Subsequently, with the addition of VSD, it can accelerate the elimination of necrotic tissue, reduce infection risk, and expedite wound healing.
CONCLUSION
This case explores the advantages and characteristics of combining various techniques in the treatment of recurrent complex pilonidal sinuses, emphasizes the utility of VSD as an adjunctive therapy for large lesions.
PubMed: 38064859
DOI: 10.1016/j.ijscr.2023.109108 -
International Journal of Surgery... Jan 2024
Topics: Humans; Pilonidal Sinus; Neoplasm Recurrence, Local; Wound Healing; Surgical Flaps; Skin Diseases
PubMed: 37738007
DOI: 10.1097/JS9.0000000000000768