# Recurrent Umbilical Pilonidal Sinus: An Uncommon Condition Successfully Treated With Omphalectomy and Umbilicoplasty

## TL;DR

A rare umbilical pilonidal sinus was successfully treated with surgery, offering long-term relief and a good cosmetic outcome.

## Contribution

The paper presents a successful surgical approach for a rare condition with limited prior case reports.

## Key findings

- Surgical excision and umbilicoplasty resolved chronic umbilical pilonidal sinus with no recurrence after one year.
- Imaging failed to detect the condition, highlighting the need for clinical suspicion in chronic umbilical discharge cases.
- The case emphasizes the importance of considering rare diagnoses in patients with persistent abdominal symptoms.

## Abstract

Umbilical pilonidal sinus is a rare subtype of chronic pilonidal disease, which more commonly affects the sacrococcygeal region. Diagnosis is often delayed due to low clinical suspicion and overlapping presentations with more common abdominal wall conditions. We report the case of a 33-year-old male with a six-year history of intermittent malodorous umbilical drainage causing significant psychosocial distress. Previous conservative management, including antibiotics, hair removal, and hygiene measures, failed to provide adequate relief. Imaging, both ultrasound and computed tomography (CT), was unremarkable apart from only mild umbilical inflammation. Operative exploration revealed a nest of hair and sinus tracts terminating in a cyst at the umbilical base. Complete excision of devitalized tissue was performed, followed by umbilicoplasty, achieving a satisfactory cosmetic result based on patient-reported outcome. The patient recovered uneventfully with no recurrence at one year. Umbilical pilonidal sinus, though rare (~0.6% of pilonidal disease cases), should be considered in patients with chronic umbilical discharge. Surgical excision with umbilicoplasty offers definitive management and reliable long-term results.