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The clinical manifestations of the same disease are diverse, and attention should be paid to distinguishing them
Written by | CHEN Qiang
Guide
If after the baby is born, parents find that there are small holes, lumps, rashes, hairs and other abnormalities in the child's buttock groove, often sleepless, feel that the child is very different, like a long tail, the first time to go to the hospital may hear the doctor talk about spina bifida.
This situation is very common in daily outpatient clinics, and no matter how small the problem is, it also concerns the hearts of parents.
Today we popularize a similar situation, the same hair, but the diagnosis is completely different Oh, why? Look down seriously.
Contents
1. What is Tibetan sinus? What's the problem?
2. Genetic or acquired?
3. What situations must be checked? How to check?
4. What should I do if I am diagnosed?
5. How to prevent it daily?
A What is Tibetan Sinus? What's the problem?
Pilonidal sinus (PS) is a condition in which chronic sinus tracts or cysts form in the soft tissues of the sacrococcygeal gluteal fissure, characterized by embedded hair, occurring during puberty and beyond (figure 1) [1].
It also has an alias called "jeep disease", which is because during World War II, soldiers sat in cars for a long time, when there were no aviation space seats on the car, poor comfort, sitting for a long time, it was easy to get this disease, so the name came from.
(Image from https://www.google.com)
It is necessary to mention recessive spina bifida here, because this disease can also be manifested as saloceccygeal hirsutism and a certain degree of confusion, but it is the most common of the recessive spinal canal insufficiency, more common in the lumbosacral region, one or more vertebrae of the lamina is not completely closed, and the spinal canal contents are not bulging.
The vast majority of occult spina bifida have no symptoms for life and no external manifestations. Occasionally detected on x-rays, occasionally pigmentation of the lumbosacral skin, umbilical convulation, hair overgrowth, or lipoma and, rarely, a fibrocord through the lamina fissure attached to the dura, nerve roots, and even tethered cord, and may be accompanied by intraspinal glial hyperplasia and/or central canal dilation.
A few cases of occult spina bifida may include low back pain, incontinence, and enuresis. Patients with symptoms of neurologic damage often present with localized skin changes with spinal endothelioid cysts (figure 2) [2].
(Image from the guide link article)
2. Genetic or acquired?
Recessive spina bifida is a congenital developmental abnormality, coming out of the mother's belly like this, so what about the Tibetan sinus, is it also the case?
The congenital theory holds that due to sacral tube residue or sacral caudal caudal development deformity, inclusions appear in the soft tissues of the sacrococcygeal region, causing the occurrence of pile sinus tract.
The acquired theory believes that the Tibetan sinus is the twisting of the buttocks and mutual friction or injury during acquired activity, so that the hair between the gluteal grooves penetrates into the adjacent skin or tissue, and the latter gradually epithelializes to form a penetrating sinus tract.
As the follicle at the root of the hair falls off, the epithelialized tube that wraps the head of the hair inhales the hair to form an inhalation sinus tract as a foreign body, and repeated chronic infections and acute infection abscesses rupture to form a pilarous sinus tract that opens in the sacrococcygeal tract, and supporters of this theory are the majority.
Acquired factors include excessive body hair (coarse, stiffer, and more vigorous hair, which is more likely to pierce the skin), deep gluteal cutter, sedentary (prolonged exposure to greater local pressure on the buttocks), family history, poor hygiene, wearing tights, and a high body mass index.
Three widely accepted theories about etiology include Karydadis' foreign body reaction theory [3], Bascom's "midline fovea" hypothesis [4], and Stelzner's retention theory [5].
Symptoms of Tibetan sinuses:
- There may be no clinical signs, only manifested as a slight bulge of the sacral tail, local skin thickening and hardening, cyst with granulation tissue, fibrous hyperplasia, often containing a tuft of hair.
- It can also manifest as an acute abscess of the sacrococcygeal region, which forms a chronic sinus tract after penetration, or temporarily heals, and finally perturbates again, so that it recurs.
- Typical symptoms include one or more pits above or near the buttock seam, visible needle-sized skin openings, small holes, redness, swelling, and sometimes purulent fluid leakage in the presence of infection.
Even if the same disease is clinically diverse, everyone must be vigilant and do not take for granted that the diagnosis is the same as others.
3. What are the circumstances that must be investigated? How to check?
Imaging is necessary if sacrococcygeal lesions involving the spine and spinal cord are suspected, particularly MRI, which is an MRI of the sacrococcygeal pilocygeal sinus [6]:
- sacrococcygeal subcutaneous sinus tract, the sinus orifice is located in the sacral 5- caudal 1 vertebral body horizontal gluteal sulcus skin;
- The sinus tract is superficial, subcutaneous between the caudal 2 and sacral 2 vertebrae, and can be confined to the vicinity of the fistula or sneak subcutaneously towards the head (above) of the sacrococcygeal vertebrae;
- The sinus tract is irregular or tortuous tubular structure, the sinus tract wall is thickened (for new granulation tissue), with a high signal of T2WI and a slightly lower signal such as T1WI; Fluid or empyema in the lumen, T2WI high intensity, T1WI slightly lower - slightly higher intensity;
- Edema of the soft tissues around the sinus tract;
- often co-infection, the wall of the sinus tract and the surrounding soft tissues are moderate - significantly strengthened;
- There is no communication between the sacrococcygeal pilocygeal sinus tract and the sacrococcygeal spinal canal and canal, and the infection does not involve the canal.
4. What should I do if I am diagnosed?
For pilitrifolia, surgery is the best treatment, of course, there are non-surgical conservative treatment, but the effect is often not good, and it is easy to recur. Different surgical methods are used depending on the size, depth, and degree of infection of the sinus tract.
Surgery should remove all of the hair tissue and sinus tract, cut to the sacrococcygeal fascia and gluteal fascia, and try to preserve normal skin and tissue. Compared with conservative management, surgery has a good response, high success rate, and low recurrence rate [5].
If the treatment is not timely, it may lead to aggravation of infection, involving the sacrum and coccyx, causing osteomyelitis, etc., long-term infection stimulation, causing local granulation tissue hyperplasia and even malignant changes.
5. How to prevent it on a daily basis?
No one wants to get sick, especially this part, one is difficult to speak, the other care is inconvenient, so how to deal with it?
- Practice good personal hygiene, bathe frequently, and keep your skin clean.
- If the buttock hair is too luxuriant, it should be shaved regularly.
- When going out to work or carry out activities, you should take precautions to avoid external injuries.
- Avoid sitting for long periods of time and try to choose a good seat.
- Overweight patients should actively lose weight.
Summary, encounter the child's sacral tail hair growth, or other abnormalities, if not sure, remember to see a specialist, do not be confused by it, although there are similar or even the same performance, but at different ages, the diagnosis is different, so the treatment plan is also different.
Bibliography:
[1] Petersen S. [Pilonidal Sinus Disease; What is the Best Treatment Option?]. Zentralbl Chir, 2019, 144(4):341-348.10.1055/a-0901-7945.
[2] Boone D, Parsons D, Lachmann SM, et al. Spina bifida occulta: lesion or anomaly? Clin Radiol, 1985, 36(2):159-161.10.1016/s0009-9260(85)80100-8.
[3] Karydakis GE. Easy and successful treatment of pilonidal sinus after explanation of its causative process. Aust N Z J Surg, 1992, 62(5):385-389.10.1111/j.1445-2197.1992.tb07208.x.
[4] Bascom J. Pilonidal disease:origin from follicles of hairs and results of follicle removal as treatment. Surgery, 1980, 87(5): 567-572.
[5] Lin Lin. Progress in the diagnosis and treatment of pilocygeal pilocygeal sinus. Chinese Journal of Proctology, 2021, 41(04): 78-79
[6] WANG Zhizhi, LAI Bingjia, MAO Jiaji et al. MRI findings of the sacrococcygeal pilonigoccygeal pilomycegeal sinus. Lingnan Modern Clinical Surgery, 2020, 20(05): 605-609.
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Source: Pediatrician Kong Lingkai
Responsible editor: Xiang Yu
*The "medical community" strives to publish content professionally and reliably, but does not make any commitment to the accuracy of the content; Relevant parties are requested to check separately when adopting or using it as a basis for decision-making.