Pilonidal disease mimicking anterior anal fistula and associated with posterior anal fistula: a two-step surgery. Case report

Pilonidal sinus of the perianal region: Difficult to diagnose

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Perianal pilonidal disease is quite rare all over the world.

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Differential diagnoses should be kept in mind in terms of perianal region diseases.

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Unusual surgical management of the perianal pilonidal sinus was demonstrated.

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This case report contributes to literature in terms of algorithm of perianal pilonidal sinus.

Background

Pilonidal sinus usually arises in the area of natal cleft in young men. Hair accumulation in the wound in the perianal region is very rare. Although pelvic magnetic resonance imaging (MRI) is used in the differential diagnosis of perianal region diseases, it is not possible to diagnose perianal pilonidal sinus by MRI.

Case

A 24-year-old male patient presented with the complaint of swelling and itching in the anus for several months. On physical examination, the area giving endure and fluctuation was detected in the perianal region. An area of ​​2 × 2 cm hyperintense in T2 was seen in pelvic MRI. In the surgical exploration, collection of hair was seen at 7 o’clock at perianal region with pus discharge. After the cavity was cleaned, crystallized phenol was applied to the area and the wound was left to secondary healing. Granulation was observed after 4 weeks.

Conclusion

Perianal pilonidal sinus is very rare in the literature and is often confused with other perianal diseases such as perianal abscess or anal fistula. In this respect, when examining perianal diseases, especially in young men, perianal pilonidal sinus should be kept in mind in the differential diagnosis.