Drainage useful in the excision and closure "per primam" of pilonidal sinus: technical notes.

Pilonidal sinus treatment is still controversial, since all the most commonly used methods cause the patients considerable discomfort ("open" method) or increase the recurrence rate ("closed" method). In view of this, we reviewed our series of 52 patients treated by "en bloc" excision of all pathological tissue following closure "per primam" of the wound, after applying an aspirating drainage, which was then removed on day 2 or 3. Routine use of the drainage, antibiotic prophylaxis continued until postoperative day 6 or 7 and thorough daily disinfection of the wound and its neighbouring skin until removal of the suture, enabled us to achieve encouraging results (slight complications in 3 cases and only one recurrence).

Acute abdomen due to wandering spleen infarction: a case report.

We report a rare clinical case of acute abdomen due to partial infarction of a wandering spleen in the pelvis in a 60-year-old woman. The patient was suffering from stabbing pain in the external lower quadrant of the abdomen, irradiating back to the lumbosacral area, together with an unremitting feverish state (38 degrees C), sickness and constipation. After carrying out serological examinations, which revealed an increase in CPK and leukocytosis, ultrasonography and CT examinations were performed, revealing a mass in the left iliac cavity, which in all probability was a wandering spleen with an abnormally long pedicle and a dyshomogeneous lower area bearing witness to a splenic infarction. The patient was therefore submitted to surgery consisting in splenectomy after lysis of the adherences, which were plainly inflammatory. A wandering spleen, especially when infarcted, is a very rare clinical condition that may be congenital or acquired. Its presence can be confirmed by serological, ultrasonographical and CT examinations and must be suspected when there is no clearly defined acute abdomen.