Journal of Cutaneous and Aesthetic Surgery

BRIDGING THE GAP
Year
: 2014  |  Volume : 7  |  Issue : 3  |  Page : 162--163

Anoscrotal median raphe sinus in a child


Anand Pandey, Rajesh Verma, Vipin Gupta, Shailendra Pal Singh 
 Department of Surgery, Uttar Pradesh Rural Institute of Medical Sciences and Research, Saifai, Etawah, Uttar Pradesh, India

Correspondence Address:
Dr. Shailendra Pal Singh
Department of Surgery, Uttar Pradesh Rural Institute of Medical Sciences and Research, Saifai, Etawah - 206 301, Uttar Pradesh
India

Abstract

Anoscrotal median raphe sinus is an extremely rare entity in children. We report a pediatric patient and describe the management of this condition.



How to cite this article:
Pandey A, Verma R, Gupta V, Singh SP. Anoscrotal median raphe sinus in a child.J Cutan Aesthet Surg 2014;7:162-163


How to cite this URL:
Pandey A, Verma R, Gupta V, Singh SP. Anoscrotal median raphe sinus in a child. J Cutan Aesthet Surg [serial online] 2014 [cited 2021 Dec 5 ];7:162-163
Available from: https://www.jcasonline.com/text.asp?2014/7/3/162/146671


Full Text

 Introduction



A sinus is an epithelium lined blind channel. It may occur anywhere, and can be a congenital or acquired condition. In the scrotum, it may be due to infection. [1],[2] Congenital scrotal sinus like anoscrotal median raphe sinus is rare being an extremely rare entity, it is being presented with a brief review of the relevant literature.

 Case Report



A 4-year-old male child was referred with a complaint of intermittent discharge from the scrotum for last two years. The discharge disappeared on taking some medication, only to recur after variable time. He had no previous history of perianal infection or bladder or bowel complaints.

On examination, there was a small opening just left to the median raphe with pus discharge. The patient was put on antibiotic course for 1 week, to which he responded. Thereafter a sinogram was performed that revealed a sinus tract. After anesthetic fitness, the patient was operated upon under general anesthesia. The sinus opening was mobilized by an elliptical incision. When the tract was dissected, it reached deep into the scrotum without any internal connections. After ligating the base the tract was excised in toto [Figure 1]. {Figure 1}

Postoperative period was uneventful, and the patient was discharged in satisfactory condition.

 Discussion



The exact etiolgy of this condition is not clear. It is believed to be a congenital condition, which arises from epithelial cells trapped after the incomplete closure of the urethral or genital folds. [3] The first description is believed to be given by Mermet. [4] However, his description was about cyst and not a sinus. However, having the same etiology, both can be taken together.

The presenting symptoms include recurring scrotal infections, perineal discharge and intermittent pain. [5] The diagnosis can be made on clinico-radiological basis. The treatment of this condition is surgical. Some have advocated laying open the tract with curettage and saucerization of the margins, [5] but complete excision of the tract, which we also performed, has been adopted by most surgeons. [3],[4],[6]

The clinical differential diagnosis can be hidradenitis suppurativa, tubercular or pyogenic epididymo-orchitis, or scrotal abscess. [2],[7] Even incarcerated inguinal hernia may present as a scrotal sinus. [1] If not diagnosed and treated accordingly, it may lead to disseminated disease or septicemia. It may also persist as a smouldering infection. Treatment as per the diagnosis may cure the patient.

Till date, this condition has not been reported in such a young patient. Other reports have been described in adults. [3],[4],[5],[6] This condition, if not properly evaluated, may lead to suspicion of other conditions like anal fistulae or hydradenitis. It may be confused with infective lesions of the scrotum. Since it appears to be an infective condition of the skin, the patient may be referred to various clinicians, including dermatologists for treatment.

To conclude, congenital anoscrotal median raphe sinus is an extremely rare condition, which is curable. Proper evaluation and treatment gives excellent results.

References

1Jain P, Mishra A. Amyand's hernia presenting as chronic scrotal sinus. J Indian Assoc Pediatr Surg 2012;17:128-9.
2Anderson BB, Cadogan CA, Gangadharam D. Hidradenitis suppurativa of the perineum, scrotum, and gluteal area: Presentation, complications, and treatment. J Natl Med Assoc 1982;74:999-1003.
3Sanchez-Conejo-Mir J, Moreno-Gimenez JC, Camacho-Martinez F. International dermatosurgery: Genitoperineal cyst of the median raphe. J Dermatol Surg Oncol 1984;10:451-4.
4Ogunbiyi SO, O'Donohoe EA, Taube M. Anoscrotal median raphe sinus tract. BJU Int 2002;90:351.
5Oliver GC, Rubin RJ, Salvati EP, Eisenstat TE, Lott J. Anterior perineal sinus. Dis Colon Rectum 1991;34:777-9.
6Asarch RG, Golitz LE, Sausker WF, Kreye GM. Median raphe cysts of the penis. Arch Dermatol 1979;115:1084-6.
7Sah SP, Bhadani PP, Regmi R, Tewari A, Raj GA. Fine needle aspiration cytology of tubercular epididymitis and epididymo-orchitis. Acta Cytol 2006;50:243-9.