Sinuses And Fistulas Notes

Sinuses And Fistulas

Sinus

It is a blind track from the surface down into the tissues. It is lined by granulation tissue.

A few examples are listed below:

1. Congenital sinus: Pre-auricular sinus, post-auricular sinus.

2. Acquired sinus:

• Median mental sinus: Results from a tooth abscess.
• Pilonidal sinus: Occurs in the midline of the anal region

Read And Learn More: General Surgery Notes

Osteomyelitis: Gives rise to a sinus that discharges pus ± bony spicules.

The most common sinus in the neck is due to tubercular lymphadenitis. It discharges cheesy material. The skin surrounding the sinus shows bluish discolouration.

Fistula

It is an abnormal communication between the lumen of one viscus and the lumen of another (internal fistula) or a communication between a hollow viscus and the exterior, i.e. body surface (external fistula).

Examples of Internal Fistulas

• Trachea-oesophageal fistula
• Colovesical fistula

Examples of External Fistulas

• Orocutaneous fistula due to carcinoma of the oral cavity infiltrating the skin
• Branchial fistula
• Thyroglossal fistula
• Enterocutaneous fistula

Causes of Persistence of a Sinus or Fistula

1. Presence of foreign body
2. Persistent infection
3. Distal obstruction
4. Absence of rest
5. Epithelialisation of the track
6. Malignancy
7. Nondependent drainage, inadequate drainage
8. Dense fibrosis
9. Irradiation
10. Specific causes—tuberculosis, actinomycosis

Please refer to the Manipal Manual of Clinical Methods, 1st edition, for clinical examination of a sinus or fistula.

Sinuses And Fistulas Investigations

Complete blood picture (CBP)—haemoglobin, total and differential count, erythrocyte sedimentation rate (ESR): ESR may be increased in tuberculosis.

• Urine sugar, fasting blood sugar (FBS) and postprandial blood sugar (PPBS) to rule out diabetes.
• X-ray of the part: To look for osteomyelitis of the mandible, toe, and any foreign body.

X-ray kidney, ureter, bladder region (KUB), ultrasound abdomen: Staghorn calculi in lumbar urinary fistula.

• Fistulography or sinusography to determine the exact extent or origin of the sinus or fistula. A dye such as lipiodol (poppy seed oil containing 40% iodine) is used.
• Biopsy from the edge of the sinus is done if a specific aetiology is suspected (for example. tuberculosis, malignancy).

Sinuses And Fistulas Management

Following are a few examples:

• Sequestrectomy for osteomyelitis.
• Control of tuberculosis for tubercular sinus in the neck.
• Removal of the foreign body, if present (clinical notes)
• If the track is well formed and epithelialised, the entire track should be removed even if the disease is under control.

Sinuses And Fistulas Basic Principles

• Antibiotics
• Adequate rest
• Adequate excision
• Adequate drainage

Sinuses And Fistulas Clinical notes

1. A patient who had undergone surgery for varicose veins had persistent seropurulent discharge from the inguinal incision. Initially, it was thought to be due to infection.

• The discharge persisted for a period of two months. The wound was explored. A gauze piece was found and removed. The wound healed well.
• Retrospective analysis of the surgery revealed slipping of the ligature applied to the long saphenous vein and several gauze pieces were used to control the bleeding point.

2. We had a 60-year-old man who had a small sinus in the loin with a watery discharge. He had seen many doctors over many years. He was treated with antibiotics and antitubercular treatment without any relief. X-ray KUB revealed a staghorn calculus.