A male aged 43, having pilonidal sinus, when examined a connection with rectum is found. A clear fistulous track is explored. I think it might get drained through Post sacral fascia => Pre Sacral Fascia => Pre Sacral Space => Levator Ani to Rectum. Is it possible or any other route?
Given that drainage is usually along the plane of least resistance, I think a pilonidal sinus draining to the rectum is of low probability. What's more likely is a fistula-in-ano tracking to the sacral region. I find that anal fistulae often extend for a long distance away from the origin.
Yes a pilonidal sinus can drain into rectum, I had operated one male and one female with such pathology. It was not rectal fistula (histology). What operation do you want to do?
Thanks friend, Only today I performed on this patient. I planned this in two stages. In first stage I intercept the fistula track in perianal area and a Ksharsutra( a special setton prepared by ayurvedic methods which works as cutting as well as draining too) is applied. After 15 days in second stage I will excise and marsupilize the Pilonidal opening.
I think that it is most likely that an anal fistula has passed posteriorly to the caudal natal cleft. Having seen hundreds of pilonidal sinuses I do no think they drain into the rectum as pus tends not to travel from superficial to deep structures, although always travels from deep to superficial.
I also think that fistula between rectum and skin, including pilonidal zone should be treated as anal fistula. The procedure aimed to close the defect of rectal wall. In case the communication will remain, fistula will relapse.
I agree with colleagues, Dr.Lund, Dr.Fung, and Dr.Julianov, it is hardly possible for the pylonidal sinus to drain into the rectum by whatever route. Will you seek for something else, please:
1) anal fistula (the probability is rather low)
2) Crohn disease (with much higher probability)
3) various cysts and tumours of the rectum or sacrococcigeal region
Unfortunately, you did not show pictures and examination data. Are there other fistula exist (-ed) on the skin or somewhere? What is the patient general status? Any history? Any relatives diseased? Any biopsy, CT performed?
Thank you for providing us with images!
As far as I understood the lower is an earlier one (without scars), isn't it?
Indeed, both the pictures resemble the pylonidal sinus much. If I remember correctly, the pylonidal sinus is classified onto 4 or 5 degrees according to its complexity, but the more the sinus complex, the more it gives fistula openinings, what is not the case. The sinus originates from the involutive caudal muscles remnants which are not connected with the rectum wall, so that the anal fistula to appeare is the least possible thing.
So and however, four interconnected questions arise at least:
1) How was ruled out the Crohn?
2) What is about histology examination results, if it taken?
3) What is about US or CT data, if performed?
4) What level and place of the rectum did the fistula develop at, and how did it look
like? (And what was done with it, if any, and what was its fate now?)
We've experienced numerous pilonidal diseases(2000 the last 3 years) as it's mainly a military disease.In rare cases of complicated pilonidal sinus it could be communicate with anal verge.When this it happens we can see pus either from internal or external opening.I don't think that pus flow is a criterion regarding the fistula origin.Anal or Pilonidal.In spite of this treatment is the same.By starting with the external open make a wide circumferencial incision to include the main fistulous tract and it''s possible branches by excision of any fibrous tissue and leave a healthy subcutaneous tissue.When you are close to the anal verge place an elastic seton by finding the tract from the anal internal opening with the help of a thin mettalic probe.Complete the operation by marsupilization of your circumferencial insicion.In about 3 weeks the seton will have dropped.
Thank you very much sir, we did it and expect to complete its treatment within a month.
I read this thread and understood that ideally no pilonidal synus should have internal opening to rectum, I have found a case of my friend who was detected with pilonidal synus with no external opening in hip line but only opening in rectum at 6Oclock position after MRI test, he was wrongly diagnoised with hemharroid before, is it possible that there is pilonoid for many years with no external opening only swelling and internal opening.
Unlikely
A fistula in ano Extralevator can mimick a pilonodal sinus
A pilonidal sinus. Will have multiple subtracts but always outside the ischiorectal fossa.
If it was found how can we be sure that it is a PNS connection and not a concomitant fistula in Ano ?