Rectum

Pilonidal Cyst

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Pilonidal Cyst, Pilonidal Sinus, Pilonidal Abscess, Pilonidal Disease

  • Epidemiology
  1. Incidence: 70,000 cases in U.S. per year
  2. Infection occurs most often in males, age 16 to 30
  • Predisposing factors
  1. Men
  2. Dark-skin
  3. Hirsutism
  • Pathophysiology
  1. Pit forms at skin disruption in gluteal fold (may be injured by embedded loose hairs)
  2. Pit plugs with hair and keratin
  3. Pilonidal Cysts forms when drainage of pit is blocked, and abscess forms when infected
  4. Sinus tracts may also develop
  • Symptoms
  1. Pain in gluteal fold
  2. No systemic symptoms
  • Signs
  1. Midline tender swelling in gluteal fold over Coccyx
  • Differential Diagnosis
  1. Hidradenitis Suppurativa
  2. Skin Furuncle or abscess
  3. Crohn Disease
  4. Perianal fistula
  5. Perianal Abscess
  6. Malignancy
  • Management
  • Pilonidal Disease without Abscess
  1. Hair removal from the gluteal cleft
    1. Weekly shaving
    2. Consider laser Epilation
    3. Topical phenol helps prevent recurrence
    4. Fibrin glue (with or without surgical excision - see below)
  • Management
  • Pilonidal Abscess
  1. Incision and Drainage under Local Anesthesia
    1. Do not make incision in midline (risk of non-healing)
    2. Make small incision lateral to midline
  2. Consider surgical referral for cyst and sinus excision
    1. Many surgical approaches exist (e.g. marsupialization, Healing by Secondary Intention, flap closure)
    2. See recurrence rates below
  • Complications
  1. Pilonidal Abscess (surrounding Cellulitis may be present)
  2. Pilonidal Sinus Drainage
  3. Recurrent infections: 10 to 90%
  • References
  1. Marx (2002) Rosen's Emergency Medicine, p. 1952
  2. Johnson (2019) Dis Colon Rectum 62(2): 146-57 [PubMed]