Umbilical Pilonidal Sinus, an Underestimated and Little-Known Clinical Entity: Report of Two Cases

Abstract

Case seriesPatient: Male, 26 • Female, 21Final Diagnosis: Umbilical pilonidal sinusSymptoms: Hair tuft in the umbilicus • pain • periumbilical dermatitis • purulent discharge from the umbilicus • skin lesions • pruritisMedication: —Clinical Procedure: Umbilicus preserving surgerySpecialty: General Surgery • Dermatology • Plastic SurgeryObjective:Rare diseaseBackground:Umbilical pilonidal sinus (UPS) is a rare disease of young, hirsute, dark men with deep navels and poor personal hygiene. UPS could easily be misdiagnosed and mistreated due to its rarity and lack of awareness of the condition by physicians. However, the diagnosis is easy to establish with physical examination and a detailed history. Although it is being diagnosed and reported more frequently, there is still no consensus regarding best treatment options.Case Report:In this report, we present two cases of UPS, one in a man and one in a woman, who had typical symptoms of pain, swelling, and intermittent malodorous discharge from the umbilicus. They had small sinus openings with hair protruding deep in the navel. Because these two patients had previous histories of failed conservative treatments, an umbilicus preserving surgery was performed for both cases. Wounds were healed in 2–3 weeks with acceptable cosmetic results. During a more than 2 year follow-up period, there were no signs of recurrence.Conclusions:In a patient presenting with a history of intermittent discharge, itching, pain, or bleeding from the umbilicus and the presence of granulation tissue with or without protruding hair and periumbilical dermatitis, the diagnosis should consider UPS, even in female patients. Treatment generally depends on the severity of the disease, ranging from good personal hygiene to surgical excision of umbilical complex. The treatment of choice for chronic intermittent cases is surgical removal of the affected portion; paying special attention to cosmetic appearance.

Non‐operative management of umbilical pilonidal sinus: One more step towards ideal therapy

“…The high incidence in young males might be due to the fact that body hair development begins with puberty and peaks after the age of 20 years. The umbilicus's depth makes it a natural site for hair collection 12 . The patients in the current study had an average age of 23 years.…”

Umbilical hidradenitis suppurativa symptoms: a case series and review of the literature

“…Table 2 | Comparisons between the two groups separated by the experience of umbilical discharge. (8), an umbolith (umbilical stone) formed by keratin and sebum deposits (9), and umbilical pilonidal sinus (UPS) (10). All are rare conditions, and thus any relationship with HS is unexplored.…”

“…All are rare conditions, and thus any relationship with HS is unexplored. UPS is defined by painful purulent, malodorous, and occasionally bloody discharge (10), caused by a sinus tract formation triggered by a tuft of hair penetrating the umbilical skin. The association between pilonidal sinus and HS was mentioned as early as 1949, when Jackman and McQuarrie (11) stated that HS is commonly confused with pilonidal sinus and vice-versa.…”

Umbilical Pilonidal Disease;Predisposing Factors & Best Modality of Management

“…Accordingly, the development of the disease is very suggestible by the concomitant availability of; invader (loose hair), the force causing hair penetration & skin vulnerability for penetration in the depth of a cleft [9]. So, once the three factors are provided at the umbilicus the disease may be developed [10]. Many predisposing factors are incriminated in the development of the disease in the literature [11].…”