Porocarcinoma “A Masquerader as Left InfraClavicular mass” A case report with review of literature

Abstract

Pilonidal sinus disease is one Clinical disease that has been shrouded with controversies in the medical literature for close to 200 years. The controversies and debates stem from the names given to it historically relating to its origin from sacrococcygeal infundibulum, congenital dermal sinus and sacrococcygeal ectodermal sinus [2] to Jeep disease in world war II [3] and finally post anal pilonidal sinus. The controversy related to its aetiology congenital vs acquired even the pathogenesis continues to be debated for over a century [1]. Today the aetiology may have been sorted but there is no universal accepted modality of treatment among Surgeons. Even within the community the choice of procedure varies from a general surgeon, to a colorectal surgeon and even among cosmetic surgeons. No other disease in history has seen the variety of surgical armamentarium options available to the treating Clinician from non operative management to Sclerosing agents, Excision with primary closure, laying open the wound to flaps and recently to Minimally invasive surgical modalities like pit picking to Endoscopic Pilonidal Sinus Treatment (EPiST) and finally Video Assisted-Ablation of Pilonidal Sinus (VAAPS). Just when we have assumed that all surgical procedures have been covered enter SiLaC procedure Sinus Laser assisted Closure and SMILE procedure Sinus Pilonidal Minimally Invasive Laser Excision!Albeit the optimal therapy that reduces recurrences and a universally accepted standard procedure incites debates among the surgical fraternity. Hence it continues to loom in controversies! The abhor associated with Sacrococcygeal Pilonidal disease persists among Surgeons worldwide simply cause its unmerited and viewed by many as a reprehensible condition hence the procedure continues to be passed along to the junior most in the surgical chain of command. The burden of costs and the social impact of sacrococcygeal pilonidal disease are enormous. At times Patients continue to be under wound care management for an amazing three to five years. Sacral Pilonoidal Disease is prevalent in Saudi Arabia therefore the aim of our study was to report the outcome at a year follow up using the Classical Limbergs Flap for sacral pilonidal disease.