Abstract

Background: Umbilical pilonidal sinus (UPS) is a rare condition characterized by the formation of a sinus tract in the umbilical region, often associated with chronic inflammation and hair accumulation. Accordingly, due to its rarity and nonspecific presentation, UPS is frequently underdiagnosed, leading to delays in appropriate management. Objective: In this article we systematically reviewed all the literature on UPS in Saudi Arabia and worldwide to formulate a clinical picture, a possible management algorithm and report noted outcomes. Case presentation: This is a 19 years old, male patient, known to have autism spectrum disorder with a prior umbilical hernia repair (when the patient was 6 years old). The patient presented to the out-patient clinic when he was 17 years of age with his parents, complaining of minimal umbilical serous discharges. Upon examination, the area had poor hygiene and villous hair all around the umbilicus. The patient was followed every 3 months with no noted changes, yet after 1 year of follow up, a small umbilical swelling 1x2 cm was noted with 2 pits and hemo-serous discharges with surrounding hair tufts, no hernial recurrence noted. The family was counselled on risks and benefits of conservative versus surgical excision, and they opted for surgical excision. The patient’s pre-operative laboratory workup was normal. Post-operatively, the patient was doing well with no complaints (e.g., pain or discharges), however after 2 weeks the patient developed a small hematoma that was aspirated, other than that the follows ups were unremarkable. Discussion: Clinically, UPS is more common in males with several correlated risk factors (e.g., hirsutism, deep navels, BMI >25 kg/m2, positive family history of pilonidal sinuses) that were derived from the analysis, in which a diagnostic criterion is proposed and a “Step-up” management approach. Conclusion: The current case report and systematic review highlight the diagnostic challenges of UPS and reviews the spectrum of management options (i.e., conservative vs surgical techniques). As there is a noted international scarcity in UPS-related data, to provide patient-centred and evidence-based care.

Key words: Umbilicus, Pilonidal sinus, conservative therapies, Umbilectomy.