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.