Pilonidal desease in children. Are all issues of pathogenesis solved?
DOI:
https://doi.org/10.11603/2414-4533.2019.3.10549Keywords:
pilonidal disease, children, pediatric surgeryAbstract
The aim of the work: to determinate the possible anatomical factors in the pathogenesis of pilonidal disease in children.
Materials and Methods. Analysis of the results of clinical and morphological examination of 37 children diagnosed with "pilonidal disease" treated from 2010 to 2017 on the basis of Vinnytsia Regional Children’s Clinical Hospital was carried out in the study. The gender distribution of patients was 26 boys and 11 girls. The average age of patients was (16.4±0.4) years. To compare the morphological structure of the pilonidal cyst with adult patients, 17 samples of previously removed tissues were used, which were registered in the archive of the regional pathanatomical bureau.
Results and Discussion. In 75 % drugs in adults, there was a lack of epithelial lining, which is the result of a long recurrence of pilonidal disease. It is contributes to the rapid chronization of the inflammatory process and the emergence of vascular walls hyalinosis in the cyst wall. Also, in almost 94 % of cases in adults the walls of the pilonoid cyst consisted of coarse fibrous connective tissue with severe lymphohistiocytic infiltration, and in the lumen they were determined derive of the skin. Similar morphological signs were detected in only 30 % of children, and in the cavity of the cyst, hair strains with signs of partial lysis that were associated with non-atrophied hair follicles were revealed. This clearly did not indicate the benefit of their exogenous transdermal penetration. In 41.66 % of children, in the histological examination around the coccygeal course, immature mesenchymal tissue was determined. Due to the tight fixation of the skin in the intergluteal fold and surrounding tissues, the movement of skin and stretching of pores, in which the secrets of the skin and its derivatives accumulate, occur during movements. They even more stretch it and in case of inflammation contribute to its unauthorized disclosure. Therefore, pilonidal disease is a polyethiologic disease, one of the reasons for which is the increased local sweating of the body, causing a number of additional provocative factors of the formation of acute abscess in the intergluteal area, maintaining chronic inflammation and recurrent course of the disease.
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