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\begin{document}

\title{A complex coexistence of pilonidal disease and an anal fistula in an
HIV/AIDS patient}



\author[1]{Elroy Weledji}%
\affil[1]{University of Buea}%


\vspace{-1em}



  
  \date{May 05, 2024}


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\selectlanguage{english}
\begin{abstract}
Anal fistula and pilonidal disease may coexist in the same patient and
may even be connected as in this case with an anal carcinoma- in situ
(Bowen's disease) in an immunodepressed patient. It is difficult to tell
if the malignancy arose from the chronic pilonidal disease or
vice-versa.%
\end{abstract}%



\sloppy


Clinical Image

\textbf{A complex coexistence of pilonidal disease and an anal fistula
in an HIV/AIDS patient.}

Elroy Patrick Weledji

Department of Surgery, Faculty of Health Sciences, University of Buea,
Cameroon

Correspondence: PO Box 126, Limbe, S.W. Region, Cameroon.
Tel:237699922144; e-mail : elroypat@yahoo.co.uk

Abstract

Anal fistula and pilonidal disease may coexist in the same patient and
may even be connected as in this case with an anal carcinoma- in situ
(Bowen's disease) in an immunodepressed patient. It is difficult to tell
if the malignancy arose from the chronic pilonidal disease or
vice-versa.

Key clinical message

Anal fistula and pilonidal disease rarely coexists. Such associations
are complex as there is a high incidence of an associated disease such
as tuberculosis etc. Treatment becomes difficult if the connection is
missed. Biopsies are obligatory.

Case

A 40-year- old HAART-naive HIV infected African woman presented with a
3- year history of a recurrent formation of an abscess and draining
sinus over the sacrococcygeal area. This chronic pilonidal sinus had
been treated with antibiotics and topical antiseptic dressings. Anal
examination was apparently normal. Wide excision of the pilonidal sinus
revealed an indurated suspicious base communicating with the posterior
anal canal. This was biopsied and the gluteal cleft closed by a
transposition fasciocutaneous flap. After three weeks of healing the
wound broke down and was allowed to heal by secondary intention. The
histology revealed an anal carcinoma-in-situ (Bowen's disease). A low
transphincteric posterior anal fistula at 6'o'clock gradually became
more prominent as she became passively and actively faecally
incontinent. She underwent a defunctioning loop colostomy but whilst
awaiting chemo-radiotherapy she died.

\textbf{References}

Pankaj G. Anal fistula and pilonidal sinus disease coexisting
simultaneously: an audit in a cohort of 1284 patients. Int Wound J
2019;16(5)

Michalopoulos N, Sapalidis k, Laskow S, et al. Squamous cell carcinoma
arising from chronic sacrococcygeal pilonidal disease: a case report. W
J Surg Oncology 2017; 15:65 Legends Figure 1: Fasciocutaneous flap
closure of natal cleft defect after elliptical excision of pilonidal
sinus\selectlanguage{english}
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\includegraphics[width=0.70\columnwidth]{figures/pilonidal-sinus-repair-(2)/pilonidal-sinus-repair-(2)}

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\end{figure}

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