Contradictory views on the acquired and congenital etiology of pilonidal disease


  • V.S. Konoplitsky National Pirogov Memorial Medical University, Vinnytsya, Ukraine
  • R.V. Shavliuk National Pirogov Memorial Medical University, Vinnytsya, Ukraine
  • V.M. Shavliuk National Pirogov Memorial Medical University, Vinnytsya, Ukraine
Keywords: pilonidal disease, children, etiology, morphology.

Abstract

Pilonidal disease is a pathology that was first described more than 100 years ago. However, it still remains the subject of discussion, because there is still no clear unambiguous definition of this pathology, nor its well-known etiology. Despite the large number of developed and substantiated theories, there are still two opposing views on the cause of pilonidal disease. Some scientists are supporters of the “congenital” theory, others – the theory of acquired origin. However, this does not clarify the ultimate goal of these studies: to develop optimal treatment tactics. The purpose of the work is to clarify the data on the etiology of pilonidal disease in children. The study is based on the results of treatment analysis of 37 children diagnosed with “pilonidal disease” who were hospitalized in the Department of Emergency Surgery of Vinnytsia Regional Children’s Clinical Hospital, of which boys – 26, girls – 11. The mean age of patients was 16.4±0.4 years. Histological sections of tissue samples were stained with hematoxylin and eosin. Microscopy and creation of a photo archive of histological specimens were performed using a light microscope OLIMPUS BX 41 at a magnification of 100 and 200, in the software environment “Quick PHOTO MICRO 2.3”. The study found that there are significant differences in the histological structure of pilonidal cysts in children and adults. In pediatric patients, mesenchymal tissue was found, which is not typical for this group of patients. It was also found that the cavity of the pilonidal cyst in children is covered with a multilayered squamous non-keratinizing epithelium, and there is almost no granulation tissue. In our opinion, pilonidal disease is a polyetiological disease, the main cause of which is the congenital features of the organism, which are realized due to socio-economic and environmental factors.

References

[1] Akinci, O. F., Bozer, M., & Uzunkoy, A. (1999). Incidence and etiological factors in pilonidal sinus among Turkish soldiers. Eur. J. Surg., 165, 339-342. doi: 10.1080/110241599750006875

[2] Bascom, J. (1980). Pilonidal disease: origin from follicles of hairs and results of follicle removal as treatment. Surgery, 87(5), 567-572.

[3] Benhadou, F., Van der Zee, H. H., Pascual, J. C., & Rigopoulos, D. (2019). Pilonidal sinus disease: an intergluteal localization of hidradenitis suppurativa/acne inversa: a cross-sectional study among 2465 patients. British Journal of Dermatology, 181(6), 1198-1206. doi: 10.1111/bjd.17927

[4] Bosche, F., Luedi, M. M., & van der Zypen, D. (2018). The hair in the sinus: sharp-ended rootless head hair fragments can be found in large amounts in pilonidal sinusnests. World J. Surg., 42, 567-573. doi: 10.1007/s00268-017-4093-5

[5] Doll, D., Bosche, F. D, & Stauer, V. K. (2017). Strength of occipital hair as an explanation for pilonidal sinus disease caused by intruding hair. Dis. Colon. & Rectum, 60, 979-986. doi: 10.1097/DCR.0000000000000795

[6] Doll, D., Matevossian, E., Wietelmann, K., & Evers, T. (2009). Family history of pilonidal sinus predisposes to earlier onset of disease and a 50% longterm recurrence rate. Diseases of the Colon and Rectum, 52(9), 5-11. doi: 10.1007/DCR.0b013e3181a87607

[7] Kallet, H. I. (1936). Pilonidal sinus the factor of adolescence. Tr. Am. Proct. Soc., 163.

[8] Karydakis, G. E. (1992). Easy and successful treatment of pilonidal sinus after explanation of its causative. Aust. N. Z. J. Surg., 62(5), 385-389. doi: 10.1111/j.1445-2197.1992.tb07208.x

[9] Lurin, I. A., & Tsema, E. V. (2013). Etiology and pathogenesis of pilonidal diseases. Coloproctology, 3, 35-50.

[10] Naeem, M., Mabood, W., Imran, M., Khattak, I., & Ahmad, M. (2019). Pilonidal disease: The changing trend in incidence based on occupation. Pak. J. Surg., 35(4), 301-305. doi: 10.1055/s-0031-1272823

[11] Muller, K., Marti, L., & Tarantino, I. (2011). Prospective analysis of cosmesis, morbidity, and patient satisfaction following Limberg flap for the treatment of sacrococcygeal pilonidal sinus. Dis. Colon Rectum, 54(4), 487-494. doi: 10.1007/dcr.0b013e3182051d96

[12] Nechai, I. A., & Maltcev, N. P. (2019). Minimally invasive methods in treatment of pilonidal disease (review of the literature). Grekov’s Bulletin of Surgery, 178(3), 69-73. doi: 10.24884/0042-4625-2019-178-3-69-73

[13] Sondena, K., Andersen, E., Nesvik, I., & Soreide, J. (1995). Patient characteristics and symptoms in chronic pilonidal sinus disease. Int. J. Colorectal. Dis., 10(3), 39-42. doi: 10.1007/BF00337585

[14] Stauer, V. K., Luedi, M. M., & Kauf, P. (2018). Common surgical procedures in pilonidal sinus disease: a meta-analysis, merged data analysis, and comprehensive study on recurrence. Sci. Rep., 8, 1-27. doi: 10.1038/s41598-018-20143-4

[15] Stone, H. B. (1931). The origin of pilonidal sinus (coccygeal fistula). Ann. Surg., 94, 317-320.

[16] Tabidze, D. L., & Saenko, V. V. (2016). Experience of radical treatment of a pilonidal cyst (epithelial coccygeal passage) with the Bascom II method (clift-lift). Surgery of Ukraine, 4, 63-66.

[17] Thompson, M. R., Senapati, A., & Kitchen, R. B. (2010). Pilonidal Sinus Disease. Anorectal and Colonic Diseases. A Practical Guide to Their Management. Springer, 3rd ed., 373-386.

[18] Tsema, E. V. (2013). Evolution of ideas about the etiopathogenesis of pilonidal disease. Surgery of Ukraine, 2, 9-22.

[19] Tsema, E. V., & Dibrova, Yu. V. (2013). Clinical and morphological aspects of the etiopathogenesis of pilonidal cysts of the sacrococcygeal region. Pathology, 29(3), 61-65. doi: 10.14739/2310-1237.2013.3.22589

[20] Zakharash, M. P., Lyshavsky, O. V., & Oak, V. A. (2010). Ultrasonography in the diagnosis and choice of treatment tactics for epithelial coccygeal course. Surgery of Ukraine, 2, 66-71.
Published
2020-05-22
How to Cite
Konoplitsky, V., Shavliuk, R., & Shavliuk, V. (2020). Contradictory views on the acquired and congenital etiology of pilonidal disease. Reports of Morphology, 26(1), 54-58. https://doi.org/https://doi.org/10.31393/morphology-journal-2020-26(1)-08