Umbilical Pilonidal Sinus: A Rare Presentation

Case Report
DOI: 10.17354/cr/2015/66
Umbilical Pilonidal Sinus: A Rare Presentation
Srinidhi M1, Bharath Kumar Bhat2
Senior Resident, Department of Surgery, Mysore Medical College and Research Institute, Mysore, Karnataka, India, 2Senior Resident, Department of
Surgery, Srinivasa Institute of Medical Sciences and Research Centre, Mangalore, Karnataka, India
1
Pilonidal sinus is common in the sacrococcygeal region. It is rare at the umbilicus. Incidence being 0.6%, we report a case of umbilical pilonidal
sinus treated in our hospital. A 20-year-old male patient was admitted to our hospital with complaints of purulent discharge from the umbilicus
since 3 months. Patient was posted for omphalectomy. Intraoperatively, a tuft of hair was found in a sinus tract communicating with the
umbilicus. Histopathological evaluation was compatible with pilonidal sinus disease. There are only a few reports of the umbilical pilonidal
sinus in the literature. Umbilical sinus tract differs from the sacrococcygeal variety in the absence of multiple tracts and low recurrence rates.
Treatment options and differential diagnosis are discussed in the article.
Keywords: Hair, Pilonidal sinus, Umbilicus
INTRODUCTION
Pilonidal sinus was first described by Anderson (1847).1
It is common in the sacrococcygeal region. It is rare at the
umbilicus. Goodall reported 163 cases of pilonidal sinus, of
which only one involved umbilicus, which makes an incidence
of 0.6%.2 There are only a few reports of the umbilical
pilonidal sinus in the literature. The other rare locations for
pilonidal sinus include the scalp,3 clitoris,4 interdigital area,5
axilla,6 penis,7 and forehead.8 We report a case of umbilical
pilonidal sinus treated at our hospital. Treatment options and
differential diagnosis are discussed in the article.
CASE REPORT
A 20-year-old male patient was admitted to our hospital
with complaints of purulent discharge from the umbilicus
since 3 months (Figure 1).
On examination, the umbilicus was central and normal
in shape but with a central discharging sinus. It was also
noted that the patient had a hairy anterior abdominal wall.
An abdominal ultrasonography ruled out a patent urachus.
Complete blood picture showed elevated total leucocyte
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Figure 1: Discharge from umbilicus
counts at 12,000/dl. Otherwise unremarkable. Blood
culture report was negative. Pus culture was positive for
Staphylococcus aureus (Figure 2).
Since the discharge did not subside with a course of
intravenous antibiotics, a diagnosis of chronic omphalitis
was made. Patient was posted for omphalectomy.
Under spinal anesthesia, omphalectomy was done with an
elliptical incision around the umbilicus.
Intraoperatively, a tuft of hair was found in a sinus tract
communicating with the umbilicus (Figure 3).
Hence, an intraoperative diagnosis of an umbilical pilonidal
sinus was made.
Corresponding Author:
Dr. Srinidhi M, #3, Block 5, Health Layout, Dattagalli 2nd Stage, Ramakrishna Nagar, Mysore - 570 022, Karnataka, India. Phone: +91-8147804657.
E-mail: [email protected]
IJSS Case Reports & Reviews | April 2015 | Vol 1 | Issue 11
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Srinidhi and Bhat: Umbilical pilonidal sinus: A rare presentation
Histopathological evaluation was compatible with pilonidal
sinus disease. Findings included granulation tissue, cellular
infiltrate of inflammatory cells, and foreign body giant cells
(Figure 4).
Follow-up revealed no recurrences.
DISCUSSION
Umbilical pilonidal sinus is a rare condition with an
incidence of 0.6%.2 It is an acquired disease. A combination
of factors account for its occurrence, which include:9
• Deep navel
• Inadequate personal hygiene
• Hairiness
• Male sex and
• Young age.
Omphalectomy is commonly performed for umbilical
pilonidal sinus.10 However, the disease can be managed
by excision of the sinus tract with umbilical preservation
without the need for omphalectomy; as it usually doesn’t
have multiple tracts and has low recurrence rates.11
Some authors advocate conservative management in the
form of hair extraction, antibiotics, skin care, and regular
dressing as the first line of treatment with surgery being
reserved for resistant and/or recurrent cases.12,13
Figure 2: Staphylococci: Gram-positive cocci in clusters
The histopathological appearance of the lesion is
characteristic of a foreign body granuloma. An epitheliallined sinus tract leads to an area of fibrosis and granulation
tissue surrounding hair shafts.
Umbilical sinus tract differs from the sacrococcygeal variety
in the absence of multiple tracts and low recurrence rates.
Thus, pilonidal sinus has to be considered among the
differential diagnosis of adults presenting with discharge
from umbilicus; the other causes of which include urachal
anomalies, omphalitis with abscess, vitelline umbilical
sinus, recurrent folliculitis, and ulcerated umbilical hernia.14
CONCLUSION
Figure 3: Sinus tract
Pilonidal sinus disease is a rare occurrence at the umbilicus.
However, it should be considered in the differential
diagnosis of patients with discharge from umbilicus;
especially in young hairy males with a deep navel.
REFERENCES
Figure 4: Histomicrograph showing granulation
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How to cite this article: Srinidhi M, Bhat B. Umbilical Pilonidal Sinus: A Rare
Presentation. IJSS Case Reports & Reviews 2015;1(11):41-43.
Source of Support: Nil, Conflict of Interest: None declared.
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