Lateral Buttock Congenital Dermal Sinus Tract -Case Report-

Abstract

A 6-month-old female presented with purulent discharge from a dimple in the right lateral buttock. A subcutaneous abscess was palpated on the right paravertebral region at the L5-S1 level. She had lowgrade fever with laboratory findings of leukocytosis and elevation of C-reactive protein levels. Klebsiella and Enterococcus species were cultured from the pus. Computed tomography (CT) clearly showed a tract traversing the subcutaneous tissue and connecting to the abscess. Magnetic resonance (MR) imaging showed no abnormality in the spinal canal. The diagnosis was infected congenital dermal sinus (CDS) in the right buttock. After normalization of body temperature and laboratory findings in response to antibiotic treatment, the dermal sinus tract was surgically removed. Intraoperative findings showed that the tract gradually tapered and ended at the subcutaneous abscess space over the lumbosacral fascia. Histological examination confirmed the lesion was dermal sinus. Although laterally placed CDS in the buttocks is extremely rare with only 5 previous cases reported, lateral CDS should be included in the differential diagnosis of a dimple in the buttocks. CT as well as MR imaging should be performed to evaluate suspected lateral CDS.

Congenital Dermal Sinus Tract of the Spine

“…2 Although congenital dermal sinus tracts are usually seen in the midline, they can also be detected in off-midline locations. 8,9 Dermal sinuses occur frequently at the lumbar or lumbosacral regions and account for 40% and 45% of all cases, respectively. 1,4,5 In contrast, cervical and thoracic regions are reported in <1% and 10% of cases, respectively.…”

“…1,3 –5 This pathology is thought to occur when the neural ectoderm fails to separate completely from the cutaneous surface ectoderm between the third and eighth weeks of gestation. 6 –8 The major clinical presentations are skin abnormalities, infections, and neurologic deficits. 1,3 –5 Congenital dermal sinus tract is commonly associated with other spinal abnormalities such as a tethered cord, inclusion tumors, and split cord malformations, 1,3,6 and treatment includes resection of tract using intradural exploration.…”

Congenital Stigmatıc Alopecıas Associated with Occult Spinal Dysraphısm

“…Secondary neurulation gives form to filumterminale and conusmedullaris, andis characterized by the fusion and subsequent partial regression of caudal cell mass. Therefore, most of the spinal cordis derived from primary neurulation and a part of the caudal tip of the spinal cord is derived from secondary neurulation [3]. On the other hand, it has been stated that spinal lipomas and tethered spinal cord were the most common spinal anomalies in OSD [2].…”

“…One of the finding of the SD is Congenital Dermal Sinus (CDS) and it is seen in about 2500-3000 live births. In the etiology of the CDS, it is usually accepted as separation failure between the neural and cutaneous ectoderm [3][4][5]. The sinus sometimes blindly ends in the subcutaneous tissue which is called dimple.…”

“…The sinus sometimes blindly ends in the subcutaneous tissue which is called dimple. [3,5]. Although Chern et al (68%), and Kriss and Desai (74%) showed that midline dimple was the most common skin lesion [6,7], only a typical dimple (≥5 mm in size and ≥2.5 cm away from the anus) is highly associated with underlying SD [7].…”