Perineal sinus - Forum

[Sweden surgeon]

I have just explored a patient with a perineal sinus that goes 12 cm up to the sacrum and I don't know what to about it. Any suggestions??

This patient had ulcerative colitis, eventually subjected to colectomy and restorative proctectomy which malfunctioned. After some years with a "workday" amount of time and labor on the toilet to empty the pouch he eventually came around to have the pouch excised and converted to a Kock-pouch which also malfunctioned. The reason is small bowel dysmotility. We took out his anus as well. He now has a Brooke ileostomy and is happy with it.

However, he has now, a year after the last operation, opened a sinus in the perineum. Discharge of bloody secretions.

I have seen a few such patietns and it is a frustrating experience to get them to heal the sinus. Surgeons used to do curretage until patient and surgeon gave it up. I have tried complete excision of the tract with dubious success. It can persist for ten years or perhaps life-long.

In the ancient days when the perineal wound was left open after APR the median healing time was 6 months and some of them developed a persistent sinus. That problem disappeared when surgeons began to close the perineal wound and stopped keeping perineal drains for too long.

[Grandpa Phil]

The following options are offered:
1. Debridment followed by meticulous postoperative wound care including Water-Pik (pulsating jet lavage) irrigations.
2.Split thickness skin grafts to the cleaned out and debrided tracts.
3. Debridement and plecement of 1 or 2 gracilis muscle transplants, depending on the volume of the cavity.

I have had success with each of the above in selected patients.

I assume you excluded a retained foreign body or osteomyelitis as possible etiologies.