International Journal of Case Reports and Images - IJCRI - Case Reports, Case Series, Case in Images, Clinical Images

   
Case Report
 
Intermammary pilonidal sinus: A rare presentation
Abdulwahid M. Salih1, Fahmi H. Kakamad2, Mustafa Hamamin Abdulqadr3
1Faculty of Medical Sciences, School of Medicine, Department Surgery, University of Sulaimani, François Mitterrand Street, Sulaymaniyah, RAQ.
2Faculty of Medical Sciences, School of Medicine, Department Cardiothoracic and Vascular Surgery, University of Sulaimani, François Mitterrand Street, Sulaymaniyah, IRAQ.
3Faculty of Medical Sciences, School of Medicine, Department Histopathology, University of Sulaimani, François Mitterrand Street, Sulaymaniyah, IRAQ.

doi:10.5348/ijcri-201610-CR-10597

Address correspondence to:
F. Hussein Kakamad
Faculty of Medical Sciences, School of Medicine
Department Cardiothoracic and Vascular Surgery
University of Sulaimani, François Mitterrand Street, Sulaymaniyah
IRAQ

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How to cite this article
Salih AM, Kakamad FH, Abdulqadr MH. Intermammary pilonidal sinus: A rare presentation. Int J Case Rep Images 2016;7(1):48–50.


Abstract
Introduction: Pilonidal sinus is a sinus that contains hairs. It occurs mainly in the sacrococcygeal area. However, it may occasionally occur in other areas like axilla, groin, interdigital web, umbilicus, nose, suprapubic area, clitoris, prepuce, penis, or occiput.
Case Report: A 16 -year-old female with chronically discharging sinus (pilonidal sinus) in the intermammary area for one year duration. Complete excision of sinus tract with abscess cavity was performed under general anesthesia. Primary closure was done. Drain was put. Histopathological examinations confirmed pilonidal sinus. The wound showed clear margins after four months of follow-up.
Conclusion: Although rare, pilonidal sinus may occur in intermammary area with relatively same presentations.

Keywords: Abscess, Hair containing sinus, Intermammary, Pilonidal sinus


Introduction

Pilonidal disease is a common medical problem that accounts for almost 15% of anal suppurations [1]. pilonidal sinus is a sinus that contains hairs [2]. It occurs mainly in the sacrococcygeal area [2]. However, it may also occasionally occur in other areas like axilla, groin, interdigital web, umbilicus, nose, suprapubic area, clitoris, prepuce, penis, or occiput [3]. The onset of pilonidal sinus is rare before puberty and after the age of forty [4]. Males are affected more frequently than females by a ratio of three to one [4]. It, clinically, presents as pain, local infection and redness [5].

Intermammary pilonidal sinus is an extremely rare condition with only five reported cases in literatures [3] [5][6] [7] [8]. We present a case of intermammary pilonidal sinus with unusually large area of induration.


Case Report

A 16-year-old female presented with a chronic discharging sinus in the intermammary area for one year duration with increasing in size and amount of discharge in last six months. Examination showed a single discharging sinus with 8x9 cm induration and tenderness. After preparation for general anesthesia, complete excision of sinus tract with abscess cavity was performed. Primary closure was done after irrigating the wound with povidone and normal saline. Drain was put which was removed six days later. Multiple histopathological examinations confirmed pilonidal sinus with a tract infiltrated by mixed inflammatory cell associated with pus cell collection with presence of scattered hair shaft in the tract (Figure 1). The wound showed clear margins after four months of follow-up.


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Figure 1: Histological Confirmation Of Pilonidal Sinus.



Discussion

In 1880, Hodge coined the term 'pilonidal' from the Latin word pilus meaning hair and nidus meaning nest [5]. It was named so because these are hair containing sinus [3]. A Pilonidal sinus is a tract with blind-end lined by granulation tissue, which connects to a cystic cavity with epithelial lining [3]. The etiology of pilonidal sinus is not well known. Two main theories are suggested: the acquired and the congenital theories. However, the majority of authors favors the former theory because pilonidal sinus appears to occur in areas other than sacrococcygeal area [2]. Pilonidal sinus usually occurs more commonly in male and in sacrococcygeal area while all reported intermammary pilonidal sinus patients, including ours, are female [3] [5] [6] [7] [8]. This may be explained by pressure effect of breast in female.

Incision and drainage are the treatment of choice for the symptomatic intermammary pilonidal sinus. In case of wide excision, the wound are left for healing by secondary intention, alternatively primary closure can be done, or plastic surgery technique is performed [3].


Conclusion

Although rare, pilonidal sinus may occur in intermammary area especially in female patients with relatively same presentations and mode of treatment.


References
  1. Clothier PR, Haywood IR. The natural history of the post anal (pilonidal) sinus. Ann R Coll Surg Engl 1984 May;66(3):201–3.   [Pubmed]    Back to citation no. 1
  2. Oueidat D, Rizkallah A, Dirani M, Assi T, Shams A, Jurjus A. 25 years' experience in the management of pilonidal sinus disease. Open Journal of Gastroenterology 2014;4:1–5.   [CrossRef]    Back to citation no. 2
  3. Sunkara A, Wagh D, Harode S. Intermammary pilonidal sinus. Int J Trichology 2010 Jul;2(2):116–8.   [CrossRef]   [Pubmed]    Back to citation no. 3
  4. Søndenaa K, Andersen E, Nesvik I, Søreide JA. Patient characteristics and symptoms in chronic pilonidal sinus disease. Int J Colorectal Dis 1995;10(1):39–42.   [CrossRef]   [Pubmed]    Back to citation no. 4
  5. Yavalkar P, Shelke R. Intermammary Pilonidal Sinus: A Case Report. Indian Journal of Medical Case Reports 2014;3(2).    Back to citation no. 5
  6. Lion-Cachet J. Inter-mammary pilonidal sinus. S Afr J Surg 1971 Jul-Sep;9(3):141–2.   [Pubmed]    Back to citation no. 6
  7. Richardson HC. Intermammary pilonidal sinus. Br J Clin Pract 1994 Jul-Aug;48(4):221–2.   [Pubmed]    Back to citation no. 7
  8. Demiralay E, Höbek A, Altaca G. Inter-mammary pilonidal sinus; an extremely rare location: case report. BTDMJB 2009;5(2):78–79.    Back to citation no. 8

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Author Contributions
Abdulwahid M. Salih – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Fahmi H. Kakamad – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Mustafa Hamamin Abdulqadr – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2016 Abdulwahid M. Salih et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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