The caudal hair sinus is a chronic sinus or cyst within the soft tissue of the intergluteal fissure of the sacrococcygeal region and is characterized by the presence of hairs. The cyst is accompanied by granulation tissue, fibrous hyperplasia, and often contains a cluster of hairs. Although the disease can be seen after birth, it mostly occurs after puberty at the age of 20 to 30 years, when symptoms appear due to increased activity of the hairy lipid glands. From 1995 to 2001, five cases were admitted to our department, and all were cured with a clear diagnosis. Since this disease is easily misdiagnosed as anal fistula, the following is a summary report.
l. Clinical data
General data: The five cases were all male young adults, with a minimum age of 19 years and a maximum age of 27 years, and an average age of 22 years. The shortest duration of the disease was 5 months, the longest was 10 years, and the average was 3 years. Clinical manifestations and treatment: the early stage showed recurrent swelling, pain and foreign body sensation in the sacrococcygeal area with limited cyst formation, and the late stage showed cyst infection and formation of superficial abscess that broke down by itself.
In 2 cases, hair was exposed after cyst rupture; the rupture did not heal for a long time and formed sinus tract in 4 cases. There was foul-smelling discharge from the swollen area above the sinus orifice by pressure, and the sinus orifice was located at the tip of the caudal bone in the posterior median line of siltation, and a tiny opening with an inward turning of the skin margin was visible. The probe could not be inserted, so it was feasible to enlarge the sinus orifice and insert the probe, and the probe traveled in the direction of the sacrum. The average depth of the sinus opening was about 2-4 cm, and the average duration of the disease was 1-3 years. All five patients underwent sacrococcygeal radiography and pantoplanar glucosamine imaging to exclude bony destructive lesions, and the diagnosis was sacrococcygeal hidradenous sinus.
The sinus was resected under low epidural anesthesia in the prone position. Methylene blue injection was injected into the sinus with pressure from the sinus opening to stain the sinus wall and then squeeze out the accumulated methylene blue in the sinus cavity to prevent staining of normal tissues after incision, then the sinus tract was incised along the longitudinal axis of the caudal bone under the guidance of a probe, and the subcutaneous tissues were incised with an electric knife, and all the stained tissues were removed with an electric knife up to the sacral fascia, and the curly hairs with sharp scraping spoon could be scraped off with both ends pointed and fine and completely free, with an average of 5 A few granulation tissues were also scraped off, and the residual cavity was flushed with hydrogen peroxide after hemostasis by electrocoagulation.
The sinus tracts were opened after extensive excision and the residual sinus cavity was filled with Vaseline oil gauze, postoperatively with antibiotics for 3-7 days and changed once a day, and the wounds were healed after 3-6 weeks.
2.Discussion
Etiology: caudal hair sinus is relatively rare in China, the last seen in the domestic literature, its pathogenesis Rogar Bearley proposed that it is due to the tip of the hair in the vicinity of the piercing into the skin, forming a short tube, and the hair is still connected to its root, the short tube then dermatomized, when the hair from the original hair follicle off, by the gravitational force generated by the dermatomized short tube inhalation. Thus, the first stage of the disease is called “piercing sinus tract” and the second stage is called “aspiration sinus tract”. The incidence of this disease is higher among the occupants of jeeps. Therefore, it is also known as “jeep disease”. The cause of the hairy sinus has not been confirmed.
Most scholars believe that this disease is related to congenital and acquired factors. According to the observation of our five patients, all of them were young and strong males with vigorous body hair, and the lesions were located in the caudal region without obvious history of trauma to the sacrococcygeal region, so the onset of the disease might be related to congenital factors. All five cases in this group were young and strong males with vigorous development of body hair, especially in the perianal and caudal areas.
Combined with the cases, we appreciate that the disease has the following characteristics.
(1) The disease mostly occurs in young men with strong and hairy body, obese. (1) The disease is more common in young men with strong hairy bodies and obese bodies. The hip groove is deeper.
(2) The onset of the disease is insidious, and there are no clinical symptoms before the infection occurs. Occasionally, internal thickening or hardening of the caudal skin can be felt, and even infection can occur, and there can be recurrent small abscesses in the caudal area, which can be easily confused with caudal skin indentation, presacral teratoma, and pre-sacral cystic masses that break down and become infected.
(3) There is a possibility of carcinoma, the tumor is mixed basal cell and squamous cell, there is also adenocarcinoma of sweat gland, so once diagnosed, it should be treated surgically.
Diagnosis and treatment: Caudal hidden hair sinus is easily misdiagnosed as anorectal fistula. In the posterior midline at the tip of the caudal bone, a soft or slightly hard mass can be ribbed, and there is often a small opening in the middle, with epithelial tissue creeping in at the edge of the sinus, making it difficult to insert a probe, and when the outer opening is enlarged or occasionally inserted, the probe is directed toward the sacrum. x-ray photography excludes destructive lesions of the sacrococcygeal bone. The diagnosis of the disease can be confirmed by surgical scratching to scrape away the total free curly hairs.
Treatment is based on wide excision of the open sinus tracts, and the primary and secondary sinus tracts are injected with methylene blue before surgery to stain the sinus walls and the cystic cavity. The scope of resection is appropriate to prevent too much resection and damage to surrounding tissues and nerves; too little resection and recurrence of lesions. Include all primary and secondary sinus tracts to facilitate early healing of the incision. Intraoperative excision with electric knife, electrocoagulation to stop bleeding, and no wire knots to prevent infection. Oiled gauze strips are filled to facilitate drainage. Delayed healing of the wound can be considered by sowing the sinus tract remnants again and removing the foreign body hair after the wound heals.
Foreign literature advocates excisional one-stage suturing, in which all diseased tissue, free muscle and skin are surgically excised and the wound is completely sutured to allow one-stage healing. In order to eliminate the deep intergluteal cleft and its negative pressure, reduce wound dehiscence, hematoma and abscess, Z formation is feasible. Pouch suturing, in which the surface portion of the sinus wall and the overlying skin are excised and the wound is wound with intestinal thread or absorbable artificial sutures to promote healing, is also performed, mostly for unresectable cases or recurrent hidden hair sinuses.
However, the following contraindications should be noted for one-stage suturing.
(1) Previous closure and recurrence;
(2) Lesions exceeding 7.5 cm in extent;
(3) No secretion is seen in the cyst;
(4) Those with too much body hair.