Pilonidal cyst lancing: Pilonidal Cyst, Infected (Incision And Drainage)
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Pilonidal Cyst, Infected (Incision And Drainage)
A pilonidal cyst is a swelling that starts under the skin on the sacrum near the tailbone. It may look like a small dimple. It can fill with skin oils, hair, and dead skin cells. It may stay small or grow larger. Because it often has an opening to the surface, it may become infected with normal skin bacteria.
The cause of pilonidal cysts has been debated since they were first recognized. It may be present at birth and go unnoticed. Injury, rubbing, or skin irritation may also cause pilonidal cysts. It can also be caused by an ingrown hair. Most likely, the cause is a combination of these things. Because some injury or irritation can lead to pilonidal cysts, it can be more common in people who sit or drive a lot for work.
A pilonidal cyst may be small and painless. If it’s inflamed or infected, you may have these symptoms:
Irritation or redness
The cyst can swell and drain on its own. The swelling and drainage can come and go.
Your pilonidal cyst was drained with a small incision using local anesthesia.
After the incision and drainage, gauze packing may be inserted into the opening. If so, it should be removed in 1 to 2 days. Antibiotics are not required in the treatment of a simple abscess, unless the infection is spreading into the skin around the wound. The wound will take about 1 to 2 weeks to heal depending on the size of the cyst.
Pus may drain from the wound for the first few days. Cover the wound with a clean dry bandage. Change the bandage if it becomes soaked with blood or pus, or if it gets soiled with feces or urine.
If gauze packing was placed inside the cyst cavity, you may be told to remove it yourself. You may do this in the shower. Once the packing is removed, you should wash the area carefully in the shower once a day. Do this until the skin opening has closed. It’s OK to direct the shower spray directly into the opening if this is not too painful.
Take acetaminophen or ibuprofen for pain, unless you were given a different pain medicine to use. Talk with your healthcare provider before using these medicines if you have chronic liver or kidney disease or have ever had a stomach ulcer or digestive bleeding. Also talk with your provider if you are taking blood-thinner medicines.
If you were given antibiotics, take them until they are gone. It’s important to finish the antibiotics even if the wound looks better. This is to make sure the infection has cleared completely.
Use antibiotic cream or ointment if your healthcare provider tells you to do so.
Once this infection has healed, the following may decrease the risk of future infections:
Keep the area of the cyst clean by bathing or showering daily.
Don’t wear tight-fitting clothing to minimize perspiration and irritation of the skin.
Pilonidal cysts that come back may be completely removed by surgery. But this can only be done at a time when there is no infection. Ask your healthcare provider for more information.
Follow up with your healthcare provider, or as advised. If a gauze packing was inserted in your wound, it should be removed in 1 to 2 days, or as directed. Check your wound every day for the signs of infection listed below.
When to seek medical advice
Call your healthcare provider right away if any of these occur:
Pus continues to come from the cyst for 5 days after the incision
Increasing redness, local pain, or swelling
Fever of 100.4°F (38.0°C) or higher for more than 2 days, or as advised by your healthcare provider
Pilonidal Cyst | UVA Health
A pilonidal cyst is a fluid-filled developmental defect at the base of the spine.
The terms cyst, sinus, and abscess refer to different stages of the disease process.
- Cyst — not infected
- Abscess — pocket of pus
- Sinus — opening between a cyst or other internal structure and the outside
While the cyst is not serious, it can become an infection and should therefore be treated. When a pilonidal cyst gets infected, it forms an abscess, eventually draining pus through a sinus. The abscess causes pain, a foul smell, and drainage.
This condition is not serious. But, since it is an infection, it can enlarge and become uncomfortable. Therefore, it should be treated.
Pilonidal Cyst Copyright © Nucleus Medical Media, Inc.
Pilonidal Cyst Causes
A pilonidal cyst may be congenital or acquired. If congenital, it probably began as a defect that existed when you were born. Sometime later, the defect allowed an infection to develop. If acquired, it may be the enlargement of a simple hair follicle infection or the result of a hair penetrating the skin and causing an infection.
The following factors increase your chance of developing a pilonidal cyst:
- Personal or family history of similar problems such as acne, boils, carbuncles, folliculitis, and sebaceous cysts
- Large amounts of hair in the region
- Tailbone injury
- Horseback riding, cycling
- Prolonged sitting
Symptoms may include:
- Painful swelling over your sacrum, which is the area just above your tailbone
- A foul smell or pus draining from that area
Your doctor will ask about your symptoms and medical history. A physical exam will be done. You will be referred to a surgeon for treatment. There are no diagnostic tests required.
Talk with your doctor about the best treatment plan for you. The choice of treatment will depend on the extent of the condition and your general overall health. Treatment options include:
As with all localized infections under the skin, hot water soaks will draw out the infection. This will not completely cure the condition, but it will help.
Incision and Drainage
The abscess is lanced, the pus drained, and the wound is packed with sterile gauze. This helps it heal from the inside out. But, this usually does not cure the problem because abnormal tissue remains.
To completely cure the condition, all affected tissue needs to be removed. This is a more extensive surgical procedure than simple incision and drainage. The surgical wound may be closed with sutures or left open to heal from the inside.
Laser Hair Removal
There are recent reports that laser hair removal in the area may be an effective treatment for pilonidal cysts.
Here are ways to reduce your chance of getting a pilonidal abscess:
- Keep the area clean and dry.
- Avoid sitting for a long time on hard surfaces.
- Remove hair from the area.
Causes, Symptoms, Treatments & Removal
What is a pilonidal cyst?
A pilonidal cyst is a round sac of tissue that’s filled with air or fluid. This common type of cyst is located in the crease of the buttocks and is usually caused by a skin infection. Pilonidal cysts are a common condition, with more than 70,000 cases reported in the U.S. every year. But many people feel too embarrassed to mention it – even to their healthcare providers.
Pilonidal cysts can cause pain and need to be treated. Pilonidal cysts can be a one-time (acute) problem or you may have chronic (returning) cysts. If they’re not treated, chronic pilonidal cysts can also lead to abscesses (swollen pockets of infection) and sinus cavities (empty spaces underneath the skin).
A pilonidal cyst (also called pilonidal cyst disease, intergluteal pilonidal disease or pilonidal sinus) is a skin condition that happens in the crease of the buttocks — anywhere from the tailbone to the anus. A pilonidal cyst can be extremely painful especially when sitting.
These cysts are usually caused by a skin infection and they often have ingrown hairs inside. During World War II, pilonidal cysts were often called “Jeep driver’s disease” because they’re more common in people who sit often.
Who can get a pilonidal cyst?
Anyone can get a pilonidal cyst, but certain people are at higher risk:
- Men (men are three to four times more likely to be diagnosed with a pilonidal cyst than women)
- People between puberty and age 40 (the average age is between 20 and 35).
- Workers who sit all day (like truck drivers and office workers).
- Overweight people (ranging from overweight to obese).
- People with thick or rough body hair (this can run in your family).
- People who wear tight clothing (this can worsen the skin condition).
Is a pilonidal cyst hereditary?
In some cases, a pilonidal cyst can be hereditary (you can inherit it from a family member). Your family history can play a role in determining if you get pilonidal cysts, for example if rough body hair runs in your family.
Is a pilonidal cyst contagious?
A pilonidal cyst is a non-contagious skin condition – you can’t spread it (just like a pimple). Currently, many researchers believe that pilonidal cysts are caused by ingrown hairs.
Symptoms and Causes
What causes a pilonidal cyst?
Experts don’t yet know all the causes of pilonidal cysts. However, they do know that ingrown hairs found in the crease of the buttocks result in a skin infection that causes a pilonidal cyst to form. Think of this condition like getting a sliver of wood stuck in your skin, except it’s an ingrown hair instead.
If it’s not treated, a pilonidal cyst can possibly lead to an abscess or a sinus cavity. Those are both signs that the skin infection is getting worse.
What are the symptoms of a pilonidal cyst?
- Quickly get medical attention if you notice any of these symptoms:
- Pain which often gets worse when you’re sitting.
- A small dimple or large swollen area between your buttocks. This is usually the pilonidal cyst. You may notice the area is red and feels tender.
- An abscess with draining pus or blood. This fluid may be foul-smelling.
- Nausea, fever and extreme tiredness (fatigue).
Can I get a pilonidal cyst while I’m pregnant?
Although pilonidal cysts are much more common in men, pregnant women can get them too. If you’re experiencing pain in your buttocks, it could be a sign of a pilonidal cyst and not just a normal discomfort of pregnancy. It’s usually best in that case to contact your provider and get checked.
Diagnosis and Tests
How is a pilonidal cyst diagnosed?
Your provider will start by giving you a full physical examination. During the exam they’ll check the crease of your buttocks for signs of a pilonidal cyst.
If you have a pilonidal cyst, it should be visible to the naked eye. Your provider might spot what looks like a pimple or oozing cyst. If so, they may also ask you several questions, including:
- Has the cyst changed in appearance?
- Is it draining any fluid?
- Do you have any other symptoms?
Very rarely, your provider may order a CT or MRI to look for any sinus cavities (little holes) which may have formed under the surface of your skin.
Management and Treatment
How is a pilonidal cyst treated?
If you are diagnosed with one or more pilonidal cysts, you will receive a treatment plan that best fits your individual case. This treatment will depend on the answers to several questions such as:
- Have you had a pilonidal cyst before?
- Have you also had any other skin issues (like an abscess or sinus) in the same area?
- How quickly are you recovering?
Depending on the severity of your symptoms, you may or may not need surgery to remove your pilonidal cyst. There are several other treatment methods available besides surgery, including:
- Draining the cyst: This procedure can happen right in your provider’s office. A small incision (cut) will be made to open and drain fluid from your infected cyst.
- Injections: Injections (phenol, an acidic chemical compound) can treat and prevent mild and moderate pilonidal cysts.
- Antibiotics: Antibiotics can treat skin inflammation. However, antibiotics can’t heal pilonidal cysts on their own.
- Laser therapy: Laser therapy can remove hair which otherwise might become ingrown and cause more pilonidal cysts to come back.
While waiting for your treatment, you can try to manage any pain you may feel by using a warm compress on the affected area to soothe your skin. You might also feel less pain when using an inflatable seat or mattress.
Will I need surgery for a pilonidal cyst?
If you have a chronic pilonidal cyst or it has gotten worse and formed a sinus cavity under your skin, it’s a serious case and you may need surgery to excise (remove) the cyst entirely. Afterward, the surgeon might either leave the wound open for packing (inserting gauze) or close the wound with sutures or a skin flap (skin taken from a healthy part of your body).
Whenever you have surgery, it’s important to take good care of your wound so it doesn’t get infected. Your provider will tell you how to keep your wound clean (including shaving the area) and how long you should keep it covered. They’ll also tell you the warning signs of infection and when you should call your provider.
Can a pilonidal cyst go away on its own?
Pilonidal cysts sometimes drain and disappear on their own. If you have chronic pilonidal cysts, your symptoms may come and go over time.
Can a pilonidal cyst be cured?
Pilonidal cysts can sometimes be cured with surgery and your skin might heal fully. However, even after surgery, a pilonidal cyst can remain as a chronic, returning condition. This is true especially if the condition has gotten worse or if pilonidal cysts run in your family.
How can pilonidal cysts be prevented?
There are several steps you can take to help prevent getting pilonidal cysts or to keep them from coming back. These steps include:
- Regularly washing and drying your buttocks (to keep the area clean).
- Losing weight (if you are currently overweight) to lower your risk.
- Avoiding sitting for too long (if your job allows) to keep pressure off the area.
- Shaving the hair around your buttocks (once a week or more). You can also try using a hair removal product to avoid getting ingrown hairs.
Outlook / Prognosis
Is a pilonidal cyst fatal?
A pilonidal cyst is not fatal in itself. Aside from the pain you may feel, though, there’s always a chance that a cyst can pose several long-term health issues. These health risks can include:
- One or more returning cysts can form in the same area (or elsewhere, but typically in the crease of your buttocks). If your cyst comes back, you have chronic pilondial disease.
- Systemic infection (when an infection spreads throughout your body). Body-wide infection can quickly become life-threatening.
- Cancer (specifically squamous cell carcinoma or SCC). SCC is rarely caused by a pilonidal cyst. But this type of skin cancer can sometimes happen if you get a pilonidal cyst. If your provider diagnoses you with a pilonidal cyst, they’ll usually take a pus sample and test it just to be sure it’s not cancerous.
Be sure to see your provider if you develop symptoms of a pilonidal cyst.
Do I need to leave work if I have a pilonidal cyst?
Depending on your symptoms, you might need to take some time off of work if you have a pilonidal cyst. This condition can cause a lot of discomfort especially if you’re sitting for a long period of time. Talk to your provider about ways to be more comfortable at work and treatment options to relieve any pain caused by a pilonidal cyst.
A note from Cleveland Clinic
Although a pilonidal cyst is not life-threatening itself, it can become more difficult to treat and turn into a chronic condition if you don’t quickly seek help. That’s why it’s important to get an exam at the first sign of any symptoms of a pilonidal cyst. Always be open with your healthcare provider about your symptoms and concerns.
Pilonidal Cystectomy Surgery: Preparation, Recovery, Care
Pilonidal cysts are extremely painful growths that form in the cleft of the buttocks and often become infected. A surgical procedure called a pilonidal cystectomy is used to remove a pilonidal cyst or abscess (boil) and surrounding infection. Cystectomy is the most effective treatment for these cysts, however, there is a high rate of recurrence and the procedure may need to be repeated.
monkeybusinessimages / Getty Images
What Is Pilonidal Cystectomy Surgery?
Pilonidal cysts develop near the crease between the buttocks, known as the intergluteal cleft. An impacted or ingrown hair follicle, along with debris like dead skin cells and dirt, become enclosed in a pocket that forms a cyst.
The ingrown hair often continues to grow under the skin, irritating the cyst leading to infection. A pilonidal abscess or boil forms and fills with foul-smelling pus. For most patients, the abscess erupts through the skin, draining pus.
A pilonidal cystectomy is often required to clear out the infection.
Pilonidal cystectomy is a minor surgical procedure that is typically scheduled and performed by a colorectal surgeon on an outpatient basis. General or regional anesthesia may be used to manage pain during the removal of an infected pilonidal cyst or abscess.
Pilonidal cystectomy is a generally safe procedure. Your doctor will discuss the benefits and risks with you before surgery. Possible risks include:
- Lengthy healing time
- Recurring pilonidal cysts
Purpose of Pilonidal Cystectomy
The pain of an infected pilonidal cyst is often excruciating. It feels as if you were to press your tailbone up against the sharp corner of a table and hold it there.
The condition is most common in men between puberty and age 40, however, women can get pilonidal cysts as well.
Risk factors for developing pilonidal cysts include having thick, wiry hair on the lower back, sitting for long periods of time, and friction, such as a belt rubbing against the skin. During World War II, these cysts were so common among GIs driving Jeeps that pilonidal disease was referred to as “Jeep seat.”
Pilonidal cysts often become infected, leading to pilonidal sinus disease. The sinus is a cavity below the skin that connects to the surface through your pores. The infection spreads from the cyst into the sinus tract and, over time, can lead to recurring infections that become increasingly severe and painful.
Signs of pilonidal sinus disease include:
- Severe pain near the tailbone
- Tenderness in the lower back
- Swelling in the area
- Foul-smelling drainage
An infected pilonidal cyst is diagnosed by a visual examination by a primary care physician, dermatologist, ER doctor, or colorectal surgeon. Ultrasound also may be used to determine the scope of the infection.
Other treatments will likely have been tried (and failed) before your doctor recommends pilonidal cystectomy.
The typical first-line treatment is to lance the boil. This can be done in your doctor’s office or emergency room using local anesthesia.
Once the area is numb, the doctor will make an incision into the abscess to drain the pus. Antibiotics are not usually prescribed for pilonidal infections unless an accompanying skin infection (i.e., cellulitis) is present.
Lancing may work to remove the initial infection, but pilonidal cysts can be complex, and they frequently return and worsen over time.
The next level of treatment is lansing and incising/draining. This is also done using local anesthesia and may be performed in the doctor’s office, an outpatient surgical center, or an emergency room setting.
This procedure involves unroofing (splitting open) the cyst, curetting (scraping out) the base, and marsupializing (suturing the edges). The wound is left open to drain. This, too, is usually a temporary fix, and the pilonidal sinus cavity experiences recurrent infections.
If the cyst does not heal after draining or you continue to have problems, a pilonidal cystectomy may be needed to surgically remove the cyst and surrounding tissue.
How to Prepare
Pilonidal cystectomy is sometimes performed as an emergency procedure during an acute flare-up of pain, but it is most often a scheduled surgery that takes place at either a hospital or outpatient surgical center.
What to Bring
Pilonidal cystectomy does not require an overnight stay and you will be discharged following the procedure. Since the surgery is performed under anesthesia, you will be not allowed to drive afterward, so arrange transportation in advance.
Don’t forget to bring your insurance documents, identification, and any additional paperwork your surgeon requires the day of the procedure.
What to Wear
It is recommended to wear something comfortable that is easy to change out of. You will be in a hospital gown for the procedure. Do not wear any jewelry and leave anything of value at home.
Food and Drink
Your doctor will instruct you on whether you will need to stop eating and drinking before the procedure. If you are going under general anesthesia, it is typically recommended to not consume anything in the eight hours before the procedure.
Your doctor will advise you on whether you need to make any alterations to your current medications. Certain drugs can interfere with medical procedures and should not be taken prior to any surgery. In particular, blood thinners may cause problems with blood clotting during surgery.
Be candid about your use of any recreational drugs, marijuana, alcohol, and nicotine, as these may affect your response to sedation.
Don’t assume that your entire surgical team knows what medications you are taking. Repeat it to them on the day of your procedure so they are aware of what you have been on and how much time has passed since you last took it.
What to Expect on the Day of Surgery
A day or two before your scheduled pilonidal cystectomy, you will be notified when to arrive at the facility to check in. The procedure itself should take about 45 minutes.
Before the Procedure
After you check in on the day of your procedure, you’ll be taken to a room to change and have a brief exam. You will review your medical history with a nurse, answer questions about the last time you ate or drank, and have your vitals checked.
From there, you will be brought into the procedure room set up with a surgical table, medical equipment, and computers. You will lie face down on the table and the surgical team will prepare the skin on your lower back for surgery by shaving and disinfecting it.
The anesthesiologist will connect you to an IV to give you medicine to relax. If you are having general anesthesia, you will be asleep for the procedure. Some patients instead opt for regional anesthesia, such as an epidural or spinal block, which numbs the area while keeping you awake and alert.
During the Procedure
Once the anesthesia has taken effect, the surgeon will use a scalpel to cut and excise the cyst and sinus, including the skin, pores, underlying tissue, and hair follicles surrounding the infection.
The area will be suctioned to remove pus and cleaned with saline. Any remaining inflamed tissue will be removed and the area will be cleaned again until no sign of infection remains.
Depending on how much tissue was excavated, the wound may be left open to keep watch for infection. If a lot of tissue has been removed, the wound may be packed with gauze. In addition, a drainage tube may be left in to help fluid continue to drain and prevent reinfection.
If the wound is large, your doctor may need to close it up with stitches. In some cases, skin flaps may need to be created in order to close the wound. There is a greater risk of recurring infection if the wound is closed after cystectomy.
After the Procedure
Immediately following the cystectomy, you will be taken to the recovery room and monitored as the sedation wears off. Once you are steady on your feet, you will be discharged with instructions for caring for the incision, bathing, and making a follow-up appointment.
The timeline for healing after pilonidal cystectomy varies based on how the surgery was performed. If your wound was stitched closed, complete healing usually takes four weeks, while wounds left open to drain can takes months to completely heal.
Most people can return to work in two to four weeks after surgery, however, it is advised to avoid strenuous exercise and activity until the area is completely healed. You will likely need several follow-up appointments.
Do not drive the first 24 hours after surgery and while you are taking narcotic medication. In general, you can drive once you feel comfortable sitting in the driver’s seat and using the brake and gas pedal. The timeline for this varies depending on your individual circumstances.
There is a high rate of pilonidal cyst recurrence. It is important to follow your doctor’s instructions carefully to ensure complete healing.
The first few days after pilonidal cystectomy can be uncomfortable. Since the wound is by your tailbone, it may be difficult to sit or find a comfortable position. Sitting on a soft pillow or donut seat may bring relief.
Over-the-counter pain relievers like Tylenol (acetaminophen) should help ease the discomfort. If not, your doctor may prescribe pain medicine to take on a short-term basis.
It is very important to keep the wound clean and dry until the skin is fully healed. Your doctor will give you instructions on how to care for the wound, including changing the packing and dressing, and bathing. Pat the area dry after showers, but avoid taking baths until the wound is healed over.
Once the site is healed, it is important to keep the skin in the buttocks crease clean and free from hair. Young men may need to shave, wax, or use hair removal cream every two to three weeks until the hair shafts begin to soften and thin out around age 30.
If you prefer a more permanent solution, laser hair removal or electrolysis may be a better option. A small study of 60 patients found post-surgical laser hair removal significantly reduces the risk of recurring pilonidal disease.
People who have jobs that require sitting for long periods of time, such as truck drivers, are at increased risk of recurrence. If you have a desk job, consider switching to a standing desk or setting an alarm to stand up and stretch your legs several times throughout your shift.
Possible Future Surgeries
Pilonidal sinus disease can be a chronic, recurring condition. About 50% of people who have a cyst removed require a second cystectomy, and some may need repeated procedures to treat pilonidal sinus disease.
A Word From Verywell
Pilonidal cysts are painful and often difficult to treat. Their location on the tailbone can make them prone to irritation and reinfection. It is important to keep the area clean, dry, and hairless to facilitate healing after a cystectomy and prevent painful infections in the future.
Symptoms, Causes, Diagnosis, Treatment, Surgery
There’s a type of cyst you can get at the bottom of your tailbone, or coccyx. It’s called a pilonidal cyst, and it can become infected and filled with pus. Once infected, the technical term is “pilonidal abscess,” and it can be painful.
It looks like a large pimple at the bottom of your tailbone. It is more common in men than in women. It usually happens more often in younger people.
People who sit a lot, such as truck drivers, have a higher chance of getting one.
They can be treated. If your cyst becomes a problem, your doctor can drain it or take it out through surgery.
What Causes a Pilonidal Cyst?
Most doctors think that ingrown hairs are the reason for many of them. Pilonidal means “nest of hair,” and doctors sometimes find hair follicles inside the cyst.
Another theory is that pilonidal cysts appear after a trauma to that region of your body.
During World War II, more than 80,000 soldiers got pilonidal cysts that put them in the hospital. People thought they were because of irritation from riding in bumpy Jeeps. For a while, the condition was called “Jeep disease.”
You might be more likely to get one if you were born with a small dimple in the skin between your buttocks. This dimple can tend to get infected, though doctors aren’t exactly sure why.
Other risk factors include obesity, large amounts of hair, not enough exercise, prolonged sitting, and excessive sweating.
The symptoms of a pilonidal cyst include:
- Pain, redness, and swelling at the bottom of the spine
- Pus or blood draining out of it
- Bad smell from the pus
- Tenderness to the touch
They can vary in size. Yours may be a small dimple or cover a large, painful area.
When Should I Call a Doctor?
A pilonidal cyst is an abscess or boil. Treatment may include antibiotics, hot compresses and topical treatment with depilatory creams. In more severe cases it needs to be drained, or lanced, to heal. Like other boils, it does not get better with antibiotics.
If you have any of the symptoms, call your doctor.
Your doctor can diagnose a pilonidal cyst with a physical exam and by asking you questions about it. Among the things they may ask you:
- When did you first feel symptoms?
- Have you had this problem before?
- Have you had a fever?
- What medications or supplements do you take?
What Can I Do to Feel Better?
Early in the infection of a pilonidal cyst, the redness, swelling, and pain may not be too bad. Some things you might want to try:
- To ease any pain, soak in a tub of warm water. Sometimes, your cyst may open and drain on its own this way.
- Take nonprescription pain medicine, but follow the dosing instructions.
- Keep the cyst and area around it clean and dry.
Antibiotics do not heal a pilonidal cyst. But doctors have any number of procedures they can try. Here are some options:
Incision and drainage: This is the preferred method for a first pilonidal cyst. Your doctor makes a cut into the cyst and drains it. They remove any hair follicles and leaves the wound open, packing the space with gauze.
Advantage — It’s a simple procedure done under local anesthesia, meaning just the area around the cyst is numbed.
Disadvantage — You have to change the gauze often until the cyst heals, which sometimes takes up to 3 weeks.
Marsupialization: In this procedure, your doctor makes a cut and drains the cyst, removing pus and any hair that are inside. They’ll sew the edges of the cut to the wound edges to make a pouch.
Advantages — This is outpatient surgery under local anesthesia. It also lets the doctor make a smaller, shallower cut so that you don’t need to take out and repack gauze daily.
Disadvantages — It takes about 6 weeks to heal, and you need a doctor specially trained in the technique.
Incision, drainage, closing of wound: In this technique, the cyst is drained, but it’s not left open.
Advantage — You don’t need to pack gauze because your doctor fully closes the wound right after surgery.
Disadvantages — You’re more likely to have more problems with the cyst down the road. It’s harder to remove the entire cyst with this method. It’s usually done in an operating room with a specially trained surgeon.’
Other surgical procedures include complete cyst and cyst wall excision along with the pilonidal sinus tracts, the use of fibrin glue, and taking (core out) only diseased tissue and the cyst out with punch biopsies.
Follow all of your doctor’s instructions about at-home care, especially if you need to remove and pack gauze. Other tips:
- Try to keep the area clean.
- Check for any signs of a new infection, such as redness, pus, or pain.
- Keep your follow-up appointments with your doctor so they can see how your cyst is healing.
A complete cure is possible, but remember that a pilonidal cyst may recur even if you had one surgically removed.
A Cyst That Makes Sitting Painful
Q. A few weeks ago I developed a very tender spot right between my buttocks. The pain was so bad that it was difficult to sit or walk. My doctor said I had an infection called a pilonidal cyst. Much to my chagrin, I had to have it lanced with a scalpel to let the pus out. She said it could recur and that I might need surgery.
What is a pilonidal cyst, and what causes it? Why might I need more surgery?
A. A pilonidal cyst develops from an ingrown hair in the skin. (The term pilonidal means “nest of hair.”) This problem tends to occur in young men who have a lot of hair, though it can occur in anyone. It develops in a tiny pit in the crack between the buttocks.
The hair grows into the skin, along a track to the skin’s surface. Doctors refer to this as a sinus track, and the condition is also called a pilonidal sinus.
Bacteria can grow in the sinus track, causing it to become infected. If the opening to the skin becomes blocked, the sinus track swells into a cyst, much like a boil. At this point, the condition is very painful, making it difficult to walk or sit.
If pus doesn’t drain out of the cyst by itself, your doctor will make a small incision in it with a scalpel. This procedure will relieve your pain and help you heal. You may also be prescribed antibiotic pills or creams.
Pilonidal cysts are prone to recur because the sinus track remains in place even after the infection clears. If it does return, surgery–usually done on an outpatient basis–may be needed to remove the track.
Several techniques for removal are used, one of which involves cutting out the skin around the track, trying to remove it in one piece and suturing the skin back together. Most of the time, this will take care of the problem. In rare cases, the problem will recur even after surgery.
More on Ears and Airplanes
Q. I read your column about health tips for airplane travel, especially regarding ear discomfort. I would like to let you know about EarPlanes, a product sold in drug stores and airport shops. These are tiny devices made of a rubbery material. They look like corkscrews, and you insert them into your ears when the plane takes off and again when you’re getting ready to land.
I used to have severe pain in my ears, and nothing seemed to help–not chewing gum, swallowing, yawning or blowing against my nose while pinching it closed. But since discovering these, I no longer have any problems.
A. I received several testimonials about EarPlanes in response to my column on air travel. These devices are designed to equalize the air pressure in your ear canal and prevent it from building up to a painful degree. They come in adult and child sizes, and cost about $5 a pair. They are supposed to be good for one flight. I’d be interested in hearing from others who have tried them, especially anyone who’s had ear pain due to flying despite trying all the usual maneuvers listed above.
Jay Siwek, chairman of the department of family medicine at Georgetown University Medical Center, practices at the Fort Lincoln Family Medicine Center and Providence Hospital in Northeast Washington.
Epithelial coccygeal passage
What is the epithelial coccygeal passage?
Epithelial coccygeal passage (ECC, coccyx cyst, coccyx dermoid cyst, coccyx dermoid fistula, pilonidal sinus / coccyx cyst, pilonidal disease, epithelial immersion of the sacrococcygeal region) is a channel several millimeters wide (or cavity) lined with skin. It refers to inflammatory diseases of the skin and subcutaneous tissue of the intergluteal fold and sacrococcygeal region.This canal is located in the area between the buttocks, above the external opening of the anus (rectum), it goes from the skin inward and blindly ends in soft tissues. Opens, such a fistulous passage usually on the skin with one or more chiseled holes and, sometimes, contains a tuft of hair. These holes can be unnoticed for a long time, since they often do not have any unpleasant symptoms and only in the case of the development of inflammation attract attention.
Important! If there are painless holes in the intergluteal fold without any additional symptoms, the disease is called asymptomatic ECC (Fig. 1).This form of EKH does not require surgical treatment and requires only careful observance of elementary hygiene rules by the patient himself and periodic examinations by a proctologist.
Figure 1. Asymptomatic course of ECC (the arrow indicates the primary opening without signs of inflammation)
With the development of an inflammatory reaction, which is usually preceded by blockage of the external opening, the epithelial coccygeal passage first manifests itself as a painful compaction on the skin in the area of the intergluteal fold (important be aware that sometimes, especially in the absence of adequate treatment, fistulous passages can acquire bizarre shapes and appear outside the specified area (Fig.2).
Figure 2. A rare form of ECC with multiple fistulas in the perianal region (arrows indicate multiple secondary fistulous holes formed as a result of a long-term chronic form of the disease)
Important! The appearance of such a form is possible with untimely and / or inadequate surgical treatment.
In the absence of adequate treatment, painful sensations increase and the seal turns into a full-fledged abscess (abscess).Further, there are usually three options for the development of the disease:
- the abscess continues to increase and forces you to see a doctor as an emergency;
- The abscess spontaneously drains itself into the existing fistulous passage, which is manifested by the outflow of pus in the area of the intergluteal fold. At the same time, painful sensations and body temperature gradually decrease and the patient can regard this as a cure, and in the future do not consult a doctor;
- The skin over the abscess is destroyed by an acute inflammatory process and the abscess spontaneously “breaks through” outward.After emptying the purulent focus, the painful sensations sharply decrease, the body temperature returns to normal.
In the last two cases, significant relief of the condition leads many patients to believe that no further treatment is necessary. However, despite the fact that in most cases the skin wound heals over time, the very cause of the inflammatory process – a purulent cavity with elements of embedded hair – remains in the soft tissues, and the prerequisites for a new accumulation of purulent discharge are created and the process is repeated.Important! With any of the options for the course of the disease, it is necessary, as early as possible, to contact a proctologist to assess the need for further treatment and exclude more serious diseases in this area.
Why is ECF formed?
For a long time, the mechanism of the disease remained a mystery to doctors, but in the 50s of the last century, an explanation was found for why this disease develops, and it still surprises both young doctors and patients. The intergluteal fold has several features: it is prone to sweating, most of the time it is squeezed by underwear and outerwear, and is difficult to reach for self-examination.When walking between the flattened buttocks, a kind of “pumping” effect occurs. The hair caught in the intergluteal fold, under the influence of this effect, is introduced into the thickness of the skin, then into the subcutaneous tissue, where an infected cavity is formed (Fig. 3). This predisposes to the development of a local inflammatory process in the intergluteal fold, which facilitates the possibility of hair penetration into the thickness of the skin.
Figure 3.The mechanism of formation of EKH:
a. Diagram of the buttocks movement when walking with the formation of the vacuum pump effect
b. Photo of the initial stage of hair penetration into the skin of the intergluteal fold
c. The scheme of development of the inflammatory process (the arrow indicates the abscess)
What are the main symptoms of the disease? How does ECH manifest?
In about half of the cases, the disease is asymptomatic for a long time. The only manifestation may be the presence of one or more holes or dimples in the skin of the intergluteal fold, from which a tuft of hair is sometimes visible.
Important! The absence of other symptoms is often the reason for the late detection of the disease, or detection of it as an accidental finding, during examinations for other problems.
Microorganisms from the surface of the skin or from the anus enter the lumen of the skin canal, formed earlier by the introduction of hair, which inevitably leads to the development of chronic, recurrent (recurring) inflammation and the formation of an abscess.
- With inflammation of the ECH, the following symptoms most often occur:
- Pain in the region of the sacrum and coccyx;
- Redness and hardening of the skin in the area of the intergluteal fold or slightly on the side of it;
- Bloody or purulent discharge from the openings of the epithelial coccygeal passage;
- Increased body temperature;
- The appearance of additional (secondary) holes along or near the intergluteal fold;
- Discharge from additional holes formed;
- General weakness;
- Inability to carry out normal physical and labor activity (Fig.four).
Figure 4. Abscess of the epithelial coccygeal passage (arrows indicate the primary holes located in the intergluteal fold. The area of the alleged abscess is limited by an orange line)
Who is at risk of developing ECC?
The disease occurs 4 times more often in men than in women. ECH belongs to the group of infrequent diseases and is detected only in 26 out of 100,000 people. Basically, young people of working age from 15 to 30 years old are sick.According to statistics, most often ECH occurs in Arabs and Caucasian peoples, less often in African Americans.
Risk factors for the development of ECC are:
- Excessive body hair
- Insufficient attention to hygiene of the coccyx area
- Sedentary lifestyle
- Wearing tight and tight clothing (pants, skirts)
What is a relapse of the disease and how to avoid it?
Another form of the disease is a relapse (re-development) of the epithelial coccygeal duct, which occurs after some time (from 1 year or more) after a previous radical surgical treatment of the epithelial coccygeal duct.
Important! At risk of recurrence of ECC are both patients who have previously undergone insufficient surgical intervention, and patients who have developed a violation of the healing process of the postoperative wound.
In case of recurrence of ECC, repeated surgical treatment is indicated, which in turn becomes more complicated, due to the development of a scar process in the intervention area, the hospitalization period increases, and the cosmetic effect worsens.
How to diagnose ECC?
The diagnosis of epithelial coccygeal passage is established after comparing the data obtained from the patient and his examination with the results of instrumental examination methods. You will need to tell the specialist in detail about when the first complaints appeared, what changes did you notice in this area before the moment of contact, remember whether there were episodes of suppuration and spontaneous opening of the EKH. The doctor will necessarily examine the intergluteal fold and the adjacent gluteal region.In some cases, with a widespread process or an atypical course of the disease, a digital examination of the rectum may be necessary. Treat this simple study with understanding, because it is important for us that the diagnosis is correct.
Instrumental studies are of great help to doctors in establishing a diagnosis and determining the extent of the process, especially with regard to the abscessing course of ECC and recurrent forms of the disease.
Instrumental methods include:
1.Ultrasound of soft tissues of the sacrococcygeal region. This diagnostic method allows you to assess the size, prevalence of the process, the presence of a connection between the purulent cavities, to identify deeply located abscesses, the determination of which by examination and palpation of this area is impossible. Ultrasound allows the surgeon to determine in advance the volume of surgery, to plan a technique for closing a skin defect after ECC removal (Fig. 5).
Figure 5. Ultrasound picture of the epithelial coccygeal passage in the projection of the intergluteal fold
(with ultrasound examination of soft tissues, directly under the skin, in the thickness of the subcutaneous fatty tissue
a heterogeneous formation with dimensions of 25×32 mm with smooth, clear contours with
2.Fistulography – the introduction of a contrast agent into the formed course and an X-ray examination. This method allows you to determine the direction of purulent passages, their connection with the primary passage and allows the surgeon to plan the operation in more detail.
In some difficult cases, additional examinations may be required:
- Anoscopy – examination of the anal canal using an anoscope – a special optical device for painless examination of the very end of the digestive tract.This study allows you to visually assess the mucous membrane of the rectum and anal canal. Anoscopy in most cases is necessary for the differential diagnosis of ECC with diseases of the anal canal and rectum.
- MRI (magnetic resonance imaging) of the pelvic organs – a study that allows you to obtain a detailed image of the area of interest in various projections, in particular the pelvis and the sacrum region. This method is more expensive in comparison with ultrasound, but it allows an accurate diagnosis in complex cases of ECC, in case of relapses of the disease, in the presence of concomitant diseases.
Additional studies will help specialists distinguish complex rectal fistulas from neoplasms of the sacrum and soft tissues of the sacrococcygeal region, disorders of embryonic development, if ultrasound is not enough to establish a diagnosis (Fig. 6).
Figure 6. MRI image of a complicated epithelial coccygeal passage (lateral MRI shows changes in the subcutaneous fat layer at the level of the sacrum and coccyx with the formation of a cavity)
How to distinguish ECC from other diseases?
Some other diseases can have manifestations similar to ECC, which requires differential diagnosis.
A furuncle is an inflammation of the soft tissues around the hair follicle. First, there is thickening and redness of the tissue around the hair. Then a white rod is formed, around which a zone of hyperemia is preserved. An ECH abscess may look like a furuncle, but a distinctive feature will be the presence of primary holes in the intergluteal fold (Fig. 7).
Figure 7. ECC with a developing abscess (the arrow indicates the primary opening.The area of the forming abscess is limited by an orange line)
The external fistulous opening is most often located on the skin next to the anus (on the perianal skin). In the presence of an internal fistulous opening, which is located in the anal canal, it can be determined using a digital examination of the rectum or with fistulography. With EKH, there is no connection between the course and the rectum, which is confirmed by probing and or during an MRI study, and upon external examination, the primary openings of the coccygeal passage are noticeable.
Presacral teratomas can have the so-called embryonic course, which opens on the skin near the anus in the form of an epithelial funnel. Presacral teratomas are located between the posterior wall of the rectum and the anterior surface of the sacrum, which can be established by digital examination. At the same time, the epithelial coccygeal passage is located under the skin on the posterior surface of the sacrum and coccyx. The final method to accurately diagnose in such cases should be MRI.
A simple, infected wound in the area of interest may occur if the patient has had a sacrococcygeal injury, surgery for a rectal fistula, or excision of the epithelial coccygeal passage. In this situation, the presence of primary ECC holes, data on the course of the disease, and the availability of information about any interventions in this area are also of fundamental importance.
Should ECH always be treated?
The form of the disease is the determining factor in choosing a method for treating ECH.Accidentally detected asymptomatic form of the disease does not require immediate urgent surgical treatment. In order to prevent the development of acute inflammation of the pilonidal cyst in the asymptomatic form of the disease, it is necessary to carry out daily hygienic measures, avoid traumatic effects on the ECC area and wear tight and narrow clothing, remove hair (with the help of periodic shaving or epilation) in the area of the intergluteal sulcus and buttocks. However, such preventive measures do not guarantee the absence of the development of ECC complications.
At the initial stages of the formation of an ECC abscess (infiltration stage), when the first symptoms begin to appear (increasing pain in the sacrum and coccyx, tissue edema in the intergluteal fold, a slight increase in temperature), it is possible to stop the inflammatory process by using antibiotics and removing the invaded hair bundle …
Important! Even if the symptoms are not pronounced and develop slowly, it is necessary to consult a specialist as soon as possible to exclude more dangerous diseases and correct treatment planning!
Treatment should only be carried out by an experienced specialist, since it is not always easy to find the line between an abscess (this condition requires mandatory surgical treatment!) And the so-called infiltrate, when surgical treatment is ineffective.Sometimes visual examination and palpation are not enough to determine the stage of the inflammatory process. Then an ultrasound examination of soft tissues comes to the aid of a specialist, which allows you to determine further treatment tactics.
Important! In all more severe cases, with other forms of the disease, surgical treatment is indicated.
In the event of an acute ECH abscess, urgent surgical treatment is indicated, which is aimed primarily at evacuating pus and promptly alleviating the patient’s condition.
How to get rid of EKH forever?
The main radical method of ECC treatment – that is, a method aimed at completely removing the source of the inflammatory process, is surgical. Depending on the prevalence of the disease, various types of surgical interventions are performed. There are over 50 different techniques for the treatment of ECC. Such a large number of possible methods of surgical treatment is due to the fact that currently there is no optimal method that could be called the “gold standard” of treatment for all patients with ECC.In each case, the choice of surgical technique should be individual: several factors should be taken into account – the clinical picture of the disease, the stage of the disease and the extent of the lesion, the possibility of temporary limitation of physical activity in the postoperative period.
Important! After some operations, it will be necessary to strictly avoid sitting for 2-3 weeks for proper wound healing. This must be taken into account when coordinating the method of surgical treatment with a doctor.The doctor can always suggest several alternative methods.
The specialist who owns and uses several of the most effective techniques will help to choose the best way.
What operation is performed in case of an abscess (acute suppuration) of an EKH?
In the case of the development of an acute ECH abscess, in most cases, it will be necessary to perform two sequential operations. Treatment of a purulent focus of EKH should be carried out in a specialized coloproctological hospital.Its main goal is to ensure the complete evacuation of purulent contents, to stop inflammation in the surrounding soft tissues, to prevent the further spread of the purulent process.
Important! Even such a simple stage as opening an EKH abscess can significantly complicate the second (main) surgical intervention if simple rules are not followed.
The incision should be small and as close to the midline (gluteal crease) as possible. During the second operation, the scar from the previously performed incision will need to be removed as a single block with the main volume of ECX tissue. The larger the primary scar, the more tissue will need to be removed in the second operation. At the same time, too small an incision should not be made, since the key to successful recovery is adequate drainage of the purulent-inflammatory focus (Fig. 8).
Figure 8.Stages of surgical treatment of an EKH abscess:
a) local anesthesia
b) incision over the place of greatest fluctuation and evacuation of purulent discharge with taking material to determine the microorganism that caused the inflammation.
Correctly performed opening of the abscess leads to the disappearance of pain, temperature and improvement of health. However, the final inflammatory processes (changes in the surrounding tissues) after the first stage of surgery (opening and drainage of the EKH abscess) usually subside within 1-2 weeks.
After the successful completion of the first stage of surgical treatment, which will be accompanied by a decrease in the manifestations of acute inflammation and, in fact, is a “symptomatic operation”, it is no less important to carry out the second stage – a radical operation aimed at the complete removal of the pilonidal cyst with the affected skin area and subcutaneous adipose tissue and the subsequent plastic stage to achieve a good cosmetic result.
Important! In acute inflammation, it is the two-stage treatment that is most effective and quickly leads to the restoration of working capacity.Despite the improvement in the condition after opening and draining the ECC abscess, it is imperative to carry out a second radical operation, since each subsequent inflammation will involve more and more unchanged tissues in the process!
With an insignificant size of a purulent focus and a high level of professionalism of the surgeon, a one-stage radical treatment of acute ECC is sometimes possible.
Long-term inflammatory changes lead to persistent pain syndrome and long periods of disability, impaired quality of life, complications and relapses after the second stage of surgical treatment, complicate the implementation of radical surgery.It is optimal to perform the second (radical) operation 3-4 weeks after the opening and drainage of the ECC abscess.
What operations are performed for chronic and recurrent forms of ECC?
Currently, there are a large number of different radical operations for the removal of ECC, each of which has its own advantages and disadvantages.
All types of surgical interventions can be divided into 2 large groups:
- Minimally invasive techniques.
- Radical surgical treatment with tight wound suturing.
Minimally invasive techniques
Minimally invasive techniques include, for example, synsectomy and laser destruction of ECC. The advantage of these techniques is that after their implementation there is no significant restriction of physical activity, it is possible to return to work on the same day after the performed surgical intervention. The disadvantage is: the possibility of performing only with small sizes of ECC (the choice of the volume and the possibility of performing is determined by the doctor after the performed ultrasound).
If the patient has only primary passages, as well as in the absence of leaks and additional passages or branches, according to additional examination methods, it is possible to carry out a minimally invasive operation – sinusectomy. This operation involves a very economical excision of the epithelial passages with a scalpel, leaving skin bridges between the primary passages. This allows you to return to work as quickly as possible, having received an excellent cosmetic result (Fig.nine).
a) view of the postoperative wound after synsectomy
b) appearance of the postoperative scar after 3 weeks after sinusectomy
b) Laser ablation ECC (diode laser)
The essence of the operation is the processing of the primary ECC moves using a laser. This makes it possible to destroy the ECH courses and prevent the development of complications of this disease.The operation uses a laser with a specific wavelength in a continuous mode. A laser beam is delivered to the ECC passages using an LED (Fig. 10). The laser power can be from 1.5 to 3 W. The total duration of work is from 5 to 25 minutes and depends on the stage of the disease, the length of the coccygeal passage. Due to the ability to concentrate its action only on the affected tissues, the procedure is minimally invasive, accompanied by minimal pain. In addition, the laser has a coagulating property, thereby minimizing the possibility of bleeding from the affected vessels.
Figure 10. Laser ablation of ECH tracts
Radical surgical excision with tight wound suturing
Such an operation, perhaps the most common in Russia, involves a more extensive sinus excision defect in local tissues. There are many opinions about how effective and safe this operation is. In the hands of an experienced surgeon, as a rule, the probability of relapse with this type of intervention does not exceed 3-5% and is easily tolerated by patients.The main disadvantage of this technology is the need to limit mobility and exclude sitting after surgery for a period from several days to several weeks.
The type of surgical intervention is finally determined after examination and obtaining the results of ultrasound of the soft tissues of the sacrococcygeal region and, if necessary, additional methods of examination.
The main modern modifications of radical treatment of ECC:
1. Excision of ECC with displacement of skin-fascial-muscle flaps
Our clinic has developed a proprietary technique (patent), which involves the creation of fascial-muscle flaps to close a postoperative wound.The essence of the technique is to move your own soft tissues and create a strong fascial frame (fascia is a strong sheath that covers the muscles of our body) in the area of intervention, which reduces the mobility of the wound edges, accelerating healing. It is the tension and excessive load on the postoperative wound that is the main factor in unsatisfactory treatment results. This technique allows you to achieve the fastest possible recovery of the patient with minimal skin incisions, a low incidence of complications and a good cosmetic result, since the postoperative scar is located in the intergluteal fold and remains almost invisible after the operation (Fig.eleven).
a) primary ECC holes located in the intergluteal fold
b) type of wound after excision of ECC followed by plastic surgery with fascial skin flaps (single interrupted sutures are imposed on the wound. The postoperative scar is located in the intergluteal groove, which provides a good cosmetic effect)
c) 3 weeks after surgery
2.Surgery for excision of ECC with plastic according to Karydakis
In 1976, the army surgeon G.E. Karydakis proposed a surgical technique for the radical treatment of the epithelial coccygeal passage. The essence of the operation was that a radical excision of all affected tissues occurs from an incision slightly displaced from the midline, located next to the intergluteal sulcus. The operation is accompanied by a small percentage of relapses and postoperative complications. However, its disadvantage is the presence of a postoperative scar outside the gluteal groove, which provides the worst cosmetic defect (Fig.12).
Figure 12. Scheme of the operation for excision of ECC with plastic according to Karydakis
3. Surgery for excision of EKH with plastic according to Bascom
American surgeon John Bascom proposed two types of surgery for different stages of the disease: in the presence of acute inflammation of the ECC – Bascom I and for the radial treatment of the disease – Bascom II. The radical operation proposed by the author is one of the most controversial in the treatment of ECH.The technique involves the removal of only insignificant areas of the skin (while preserving the subcutaneous tissue) containing the primary openings of the ECC. Excision of a large pilonidal cyst, if present, is performed from an incision made aside from the median fold.
Figure 13. Diagram of the operation for excision of the ECC with plastic according to Bascom
Another, previously popular, method of surgical treatment of ECC is the method of marsupilization, which involves excision of the fistulous passage in a single block with skin and subcutaneous fat, followed by suturing the skin edges to the bottom of the wound.However, at present, this technique is practically not used due to the long rehabilitation period and unsatisfactory cosmetic results (Figure 14).
Skin grafting after radical surgical treatment of ECC
The main problem of wound healing after excision of ECC is the presence of a wide soft tissue defect. The subcutaneous tissue in the sacral region is tightly fixed to the underlying aponeurosis and fascia, therefore, when the defect is closed with the remaining soft tissues, tension is created, which is accompanied in the postoperative period by a high risk of dehiscence of the wound edges and prolonged healing.
The problem of closure of the formed defect with local tissues with plastic skin flaps is especially important in chronic and recurrent forms of the disease.
There are various forms and types of skin-subcutaneous flaps (Z, V-Y-shaped, Limberg-flap) for closing a defect that has arisen after ECC removal. The possibility and necessity of using one or another type of plastic is determined by the doctor on the basis of the examination data, the characteristics of the operation, the volume of removed tissues, and the patient’s wishes.
Figure 14. Options for closing a postoperative wound defect after excision of ECC:
a) plastic according to Limberg
b) Z-shaped plastic
How to choose the right clinic and surgeon for treatment in my case?
Summing up the review of surgical methods of treatment, it should be said that the choice of the type of operation is undoubtedly the prerogative of the surgeon, but today this decision is made jointly with the patient..When discussing the plan of surgical intervention (the scope of the surgical intervention) specifically in your case, the surgeon should offer you various modern instruments (devices) necessary for the operation, while telling the advantages and disadvantages of their use. If in a conversation with you the surgeon does not try to discuss different approaches to the treatment of your specific ECC, but offers an uncontested method, then this often indicates that there is no place for other methods in his arsenal.
In such a situation, you have the right to contact another doctor for a “second” opinion. It is necessary to be especially careful in the choice of both the surgeon and the institution for surgical treatment in the case when there is a complex or recurrent ECH, when treatment is often associated with extensive excision of tissues in the sacral region.
How do I prepare for the operation?
The evening before hospitalization in the hospital for surgical treatment, it is necessary to shave the sacrococcygeal and, if necessary, the gluteal region.It is possible to perform laser (alexandrite or diode laser) or photoepilation a few days before hospitalization. However, the last two methods are ineffective for light hair removal. Another method of hair removal is electrolysis, which is more painful, but suitable for all hair types. The effect after the procedures may not be achieved immediately, so it is better to perform them in advance – 14 days before the operation. Shaving, as an alternative to hair removal, will take you less time and money, but at the same time, skin damage is possible, which can become a source of infection.No other special preparation for the operation is required; it will be enough to refuse food and liquids 8 hours before the operation.
What to do in the postoperative period?
The period of time required for full recovery after surgery is usually no more than 3 weeks, but in rare cases it can be up to 1 to 3 months. The duration of the period of disability rarely exceeds 21 days, and the use of modern surgical technologies makes it possible to transfer the operated patient to an outpatient follow-up regimen as early as 1-2 days after the operation.You need to be prepared for the fact that after the operation in the area of the postoperative wound, a drain will be installed for several days to actively remove the discharge from the wound for several days. In the hospital, and then at the outpatient stage, you will be bandaged to control wound healing. The attending physician and medical staff will tell you in detail what work and rest regimen should be followed in the immediate postoperative period. In rare cases, antibacterial drugs will be prescribed for several days.It may also be necessary to monitor wound healing with ultrasound.
Are there ways to prevent relapse / recurrence of the disease?
Despite the radical nature of the operations performed, there is always a risk of a relapse of the disease. To reduce this risk, it is recommended:
- observance of the rules of personal hygiene and the peculiarities of postoperative wound care, which will be announced by the medical staff;
- shaving the sacrococcygeal region for 3 months after surgery;
- Restriction of sitting for 2 weeks and intense physical activity for 2 months after surgery.
- timely visits to the attending physician in the early postoperative period
Epithelial coccygeal passage – symptoms, diagnosis, treatment at the TS Clinic in Krasnodar
The epithelial coccygeal passage, or pilonidal cyst (translated from Latin “nest with hair”), is an anomaly located in the space between the buttocks.
The cyst looks like a painful seal, the skin above it is reddened, often in the area of the seal there are one or more holes with purulent discharge.Most often, the disease is diagnosed in people from 16 to 25 years old, while men are prone to its development 4 times more often than women.
For the first time, the pilonidal cyst in medical circles was talked about during the Second World War, when several thousand American military personnel were found to have signs of this disease. Due to the fact that many patients often had to drive off-road vehicles on bad roads, the disease was called “jeep disease”.
In some cases, a pilonidal cyst can proceed without any noticeable signs and be detected only during external examination – a depression or hole in the skin (sometimes several holes) with a diameter of 1-2 mm is clearly visible in the intergluteal fold.But when an infection gets in, inflammation begins, which brings a lot of suffering to the patient.
Patients with a pilonidal cyst complain of:
- skin redness
- The appearance of edematous areas in the region of the sacrum and coccyx
- temperature rise
- the outlet of purulent exudate from the holes in the skin.
Why is a pilonidal cyst dangerous?
In an uninfected state, the pilonidal cyst does not pose a health hazard and practically does not cause inconvenience to a person.But, unfortunately, with suppuration, the cyst often turns into a chronic (fistulous) form and bothers you regularly. A timely diagnosis allows you to prescribe adequate treatment and completely save the patient from this obsessive problem!
Pilonidal cyst treatment
Treatment for a pilonidal cyst requires surgery.
At the moment of exacerbation, the first stage is the opening of the abscess, then, in a calm (outside the acute) period, the removal of the cystic cavity with all fistulous passages and leaks is performed under general anesthesia.
In order for the operation to give the necessary results, the patient must carefully follow a number of rules:
- Do not take a sitting position in the first 3 weeks after the operation, but lie on your back very carefully
- not to play sports or hard physical labor during the month
- hygiene procedures should be carried out only after removing the threads, using special means
- After hygiene procedures, the operation site should dry naturally
- visit a doctor every 7-14 days to monitor the process of tissue regeneration.
Important! Full recovery usually occurs 6 weeks after surgery, but in 10-40% of cases, the disease recurs, which requires repeated tissue excision.
Prevention of a pilonidal cyst
To prevent the development of a coccyx cyst, it is necessary to avoid hypothermia and injuries to the sacrococcygeal region, as well as devote enough time to personal hygiene, and this is especially true for men with thick hair in the lower back.Since in many cases it is impossible to determine the exact cause of the disease, it is necessary to consult a doctor at the first symptoms of its development.
Epithelial coccygeal passage: symptoms, diagnosis, treatment without relapse
Epithelial coccygeal passage, or pilonidal cyst, is a disease in the region of the sacrum and coccyx, with an exacerbation of which there is damage to the skin and subcutaneous fat. A pilonidal cyst is a capsule-shaped cavity that is located under the skin in the intergluteal fold.This cavity contains hair, sebum, bacteria accumulate. The cyst has a communication with the skin – fistulous passages in the fold between the buttocks.
Stages of pilonidal cyst formation
- Several primary sinus tracts are found in the crease between the buttocks. Through them, the contents of the cyst are periodically excreted in small quantities. At this stage, the disease is asymptomatic.
- As the subcutaneous cyst grows, larger secondary fistulous passages join the primary fistulous passages.Through these wide channels, the contents of the cyst come out in a larger volume.
- Pilonidal abscess – cyst suppuration. It occurs when the existing fistulous passages are not enough for pus to come out. The acute form is characterized by soreness of tissues in the area of the cyst, an increase in temperature, an increase in the release of pus with an unpleasant odor, it is difficult for the patient to sit
Treatment of epithelial coccygeal passage both in the acute period and without exacerbation occurs only by surgery.
Diagnostics of the epithelial coccygeal passage includes a survey, a visual examination of the patient by a proctologist and a digital examination. This is usually enough to make a diagnosis. If it is necessary to clarify the diagnosis and exclude other diseases masquerading as symptoms of a pilonidal cyst, tomography of the lumbosacral spine, ultrasound of soft tissues, fistulography can be prescribed to determine the position of the fistulous passages and their connection with the cyst.
In the Odrex clinic, surgical treatment of the epithelial coccygeal passage is carried out by the method of marsupialization. The technique shows good results both for uncomplicated cysts and for extensive cysts in the stage of acute inflammation. Removal of the epithelial coccygeal passage is carried out simultaneously, by excision of all pathological tissues: cysts, fistulous passages, old scars – to the periosteum. The postoperative wound is partially sutured. This is done to reduce the volume of the wound and speed up healing.Moreover, in comparison with the closed method of surgical treatment, the affected area is better cleared of possible remnants of necrotic tissue, hair follicles, and fragments of the epithelial passage.
And most importantly, this method minimizes the likelihood of complications and relapses of the disease.
The operation is performed under general or spinal (epidural) anesthesia. The duration of the operation is from half an hour to 1 hour.
After the operation, it is necessary to be in stationary conditions in a supine position for at least 5 days so that the stitches do not cut through.The stitches are removed on day 12. During this period, the patient comes to the hospital several times for medical supervision and planned dressings. Full recovery after surgery takes up to 1 month. At this time, the patient is advised to limit physical activity, avoid prolonged sitting.
In some cases, the operation can be divided into two stages. The decision is made by the doctor depending on the patient’s condition, the stage of the disease, the type of cyst and fistulous passages. Two-stage treatment is used in the case of advanced cyst abscesses with multiple fistulous tracts.First, measures are taken to eliminate the inflammatory process, and after a few months, a radical removal of the epithelial coccygeal passage and cysts is routinely performed. By itself, opening an abscess does not cure the disease. If the cavity in the subcutaneous fat, which is the cause of the disease, is not eliminated, relapses of the disease will occur.
Causes of epithelial coccygeal passage
There are two main approaches to explain the occurrence of the epithelial coccygeal passage.It is assumed that it is associated with abnormalities in the developmental stage of the embryo. At the same time, channels remain under the skin in the coccyx area, which appear on the skin as small holes, similar to enlarged pores. The canals are covered from the inside with epithelial tissue with hair follicles, sebaceous and sweat glands. Inflammation of the epithelial coccygeal passage usually occurs during puberty, when intense hair growth and sebum production begins. According to another theory, the epithelial coccygeal passage is formed due to the anatomical and hormonal characteristics of a particular person.Factors such as deep intergluteal fold, pronounced buttocks, excessive hair growth can lead to ingrowth of hair into the skin and the formation of an epithelial coccygeal passage.
Question – answer
Does the epithelial coccygeal passage extend to bone?
As a rule, the disease does not affect the bone, rectum and colon.
What external factors provoke inflammation of the epithelial coccygeal passage?
A patient may be unaware of the existence of a coccygeal cyst for a long time.Under unfavorable circumstances, such as trauma, hypothermia, decreased immunity, the pilonidal cyst becomes inflamed, suppuration occurs. The disease is manifested by pain, redness. Pus can burst through the fistula. Symptoms of inflammation of the epithelial coccygeal passage may decrease, but this is a temporary improvement – until the next provoking situation.
Who is more likely to have a pilonidal cyst?
The disease is common among both men and women.Inflammation of the epithelial coccygeal passage in men occurs several times more often.
Can a coccyx cyst recur after surgery?
Recurrence of the disease may occur due to incomplete removal of the epithelial passage or re-ingrowth of hair into the healing wound. With the correct choice of the method of surgery and adherence to hygiene recommendations, the risk of recurrence is minimized.
Is it possible to treat the epithelial coccygeal duct without surgery?
It is impossible to recover without surgery.Moreover, if for a long time there is a constant inflammation of the tissues, it is possible that the coccygeal cyst degenerates into a malignant formation (sarcoma).
Coccyx cyst treatment | MAJOR CLINIC
How does a coccyx cyst manifest?
In the area of the gluteal fold, at a distance of 6-10 cm above the anus, a rounded formation of small diameter appears. Gradually, it increases in size and begins to cause discomfort. A doctor may suspect a tailbone cyst during an examination.The cyst has several names reflecting the stages of the development of the process:
- Epithelial coccygeal passage – the stage of cavity formation in the epithelial space.
- Dermoid Sinus – The cavity is defined directly under the skin.
- Pilonidal sinus – when the hairline is introduced under the skin layer.
- Inflammation of the coccyx cyst (fistula) – purulent contents are released from the opened cyst.
A cyst on the coccyx in women is found less often, but manifests itself in the same signs as in the stronger sex.
Factors provoking the appearance of a cyst:
- decrease in physical activity;
- sedentary work;
- increased hair growth;
- tendency to boils;
- relatively small pore sizes that are easily clogged with sebum;
- Frequent hypothermia of the lower body;
- reduced immunity;
- contact of the buttocks with rubbing coarse clothing.
90,035 frequent illnesses, especially of an infectious nature;
Coccyx cyst: symptoms
- Discomfort in the gluteal fold, aggravated by movement.
- Edema in the sacrum region, less often – more widespread, with perineal involvement.
- Hyperemia of the skin above the coccyx.
- Opening of the embryonic passage.
- The appearance of purulent discharge (they say: purulent cyst of the coccyx).
- Increased body temperature.
- Pain when sitting.
- Next to the first move, other, child ones are opened (the more the process is started, the more secondary moves).
This is how the coccyx cyst manifests itself. Symptoms are typical enough to consult a doctor and undergo treatment after a thorough diagnosis.
If you have discomfort in the gluteal fold, be sure to take the time and make an appointment with the proctologist. The doctor will ask about when the unpleasant symptoms appeared, how you dealt with them. He will conduct an examination and appoint the necessary examination.
- Sigmoidoscopy helps to carefully examine the intestinal mucosa, to determine the site of the lesion.
- Probing of the cyst is carried out to identify the canal of the coccygeal passage, the place of its exit into the intestine and on the skin.
- Ultrasound to clarify the localization and extent of the process.
- X-ray of the sacral zone with contrasting cysts.
- CT or MRI.
Coccyx cyst: treatment
Only surgical treatment is possible. Surgery is performed to completely remove the cyst and all the passages (canals). It is very important to carry out the operation as planned, in this case the probability of complete removal of the coccyx cyst is much higher.
There are several options for surgical intervention, differing in access, technique of performing the intervention and cutting instrument. For example, an ordinary scalpel, a radio knife can be used, or a coccyx cyst can be removed with a laser. The method of intervention is selected by the doctor, focusing on the individual characteristics of the patient.
- complete excision of the cyst and tracts without suturing the wound;
- complete excision of the cyst and tracts with wound suturing;
- Excision of cysts and passages with skin plastics.
One thing is certain: there is a coccyx cyst – an operation is needed. The intervention itself lasts 20-60 minutes. The time depends on the number and length of epithelial passages, that is, on the volume of the operation.
Contraindications to the operation are:
- high body temperature;
- pronounced purulent process;
- severe liver or kidney disease;
- malignant tumor.
What to do after removing the cyst
- Carefully carry out hygiene procedures.
- Wear recent underwear.
- You can lie on your back in a week.
- Sit down – in three weeks.
- Exercise – in a month.
- Visit a proctologist regularly.
- After complete healing, it is necessary to lead an active lifestyle and adjust the diet in accordance with the recommendations of the doctor.
How is coccyx cyst treated without surgery?
Only an operation will surely get rid of the disease.Any other methods can only delay it. But such a delay is not always beneficial. With an untreated tailbone cyst, a number of complications can develop. More and more abscesses and fistulous passages are formed.
The infection will spread to adjacent tissues, leading to paraproctitis, osteomyelitis and even sepsis. Constant skin irritation will trigger the development of eczema, a very painful condition that takes a long time to heal. Therefore, it is better not to waste time, but to see a doctor as early as possible.Then the surgical intervention will be small, and the rehabilitation period will be shorter.
MAJOR CLINIC clinic is equipped with everything necessary for high-quality diagnosis of coccyx cysts. We employ highly qualified experienced doctors. An optimal operation can be performed to remove the coccyx cyst, its price depends on the chosen intervention. All this should be discussed in an in-person consultation with a doctor. You can sign up by calling the registration desk or on the website.
Treatment of the epithelial coccygeal duct (ECH, coccygeal cyst, pilonidal sinus)
Treatment of the epithelial coccygeal duct (ECH, coccygeal cyst, pilonidal sinus)
Epithelial coccygeal duct (ECH) – a formation localized in the sacrococcygeal region along the middle line, which is a narrow channel that opens with one or, more often, several punctate holes in the skin between the buttocks.The coccygeal passage blindly ends in the subcutaneous tissue and is not associated with the coccyx. On the lining the course of the epithelium there are hair follicles, glands (sweat and sebaceous).
The reasons for the emergence of of this formation are not reliably known, according to the embryonic theory, the course is formed as a result of a congenital defect in the development of the caudal part of the embryo and is the remnants of a rudimentary “embryonic tail”. This anomaly is quite common. Its signs can be found in many people who consider themselves absolutely healthy, and such a cyst is absolutely asymptomatic and does not manifest itself.
However, in some people, the pilonidal sinus will one day make itself felt. There are pain in the sacrum , at first not expressed, then, when the inflammation spreads to the surrounding tissue, unbearable, edema , purulent or bitchy discharge with the development of inflammation and suppuration. Sometimes these initial manifestations coincide with trauma to the sacrococcygeal region, prolonged sitting position, and insufficient hygiene of the intergluteal fold.The disease often manifests itself during puberty in young people or adolescents, since with the onset of puberty, active hair growth begins in the lumen of the epithelial cyst, and the production of sweat and sebaceous glands increases. The relative proximity of the anus determines the microbial contamination of the sacrococcygeal region. The body temperature may rise.
It is important to have time to seek help from a surgeon or proctologist at an early stage of the disease (stage of infiltration), when the formation of an abscess has not yet occurred.In this case, it is possible to perform a radical intervention. However, such a development is extremely rare.
At the stage of an abscess, during the initial treatment for help, only an opening and adequate drainage of the abscess can be performed. The patient feels significant relief, however, since the cause has not been eliminated, a recurrence of episodes of suppuration in the future is possible. And with each subsequent episode, the disease only progresses more, and the frequency of visits increases. In this regard, there is no need to wait and hope that “maybe it will not happen again”, but timely perform a radical intervention – excision of ECX , waiting for the next period of remission (when healing has begun).
Patient’s unconsciousness, at times, leads to refusal of radical intervention even after several episodes of suppuration of ECC, which leads to the spread of the process from local to widespread, with damage to the soft tissues of the buttocks, lower back, and even the back. In this case, the surgeon is already faced with a big problem, which can only be dealt with by performing several (instead of one simple with timely treatment) reconstructive operations with moving and cutting out complex flaps.
In other words, if once an episode of ECH inflammation has arisen successfully ended, then even in the absence of symptoms (pain, edema, discharge of pus), the patient cannot hope for a final recovery due to the preserved focus of chronic inflammation.
Treatment of ECC is only surgical.
The choice of the method of surgical intervention is determined by a specific clinical case (depending on the stage of inflammation, volume and localization of purulent inflammation, anatomical features of a particular patient) during examination by a specialist.
Primary excision, excision with various methods of wound closure (deaf, return sutures according to Donati,) or without closure at all (open wound management), marsupilization, reconstructive plastic surgery (with covering the wound defect with various types of flaps)
Despite the seeming simplicity of surgical interventions, their effectiveness directly depends on the technique of execution and the experience of a specialist. That is why a radical operation should be carried out in specialized proctological departments, centers, or surgical hospitals (hospitalization period – 5-7 days ).Insertion and drainage of the primary abscess, as a rule, is performed under local anesthesia (there are quite rare exceptions when general anesthesia is needed), possibly in a center with a short-term stay of patients (on average 1-2 days hospitalization) or even in a well-equipped outpatient proctological office.
Epithelial coccygeal passages
Epithelial coccygeal passage (coccygeal cyst, epithelial coccygeal cyst, coccygeal fistula, coccyx fistula, pilonidal sinus) – is a congenital defect in the development of soft tissues of the sacrococcygeal region, which affects mainly young people from 15 to 30 years old.(fig. 1.)
Fig. 1. Coccyx cyst and epithelial coccygeal passage.
Even during the formation of the child’s body, each embryo in the coccyx region has a protrusion in the form of a tail. In the process of development, this protrusion begins to decrease, pulling in a fold of skin behind it. This fold of skin in the subcutaneous fat in the form of a fistulous tract exits the skin with one or more holes in the apex of the coccyx.
Many people live with this education and do not even know about its existence.In this fistulous course, inflammation can occur, which can be triggered either by mechanical injury, or by activation of the microflora. From this moment on, the patient is worried about pain, swelling, redness, sometimes – the discharge of pus in this area, an increase in temperature.
First of all, other diseases that outwardly resemble epithelial coccygeal passages should be excluded, namely: presacral cyst, osteomyelitis of the coccyx or sacrum, meninocele, paraproctitis and other
TREATMENT OF EPITHELIAL COPTIC TRAIN AND COPY CYST
Treatment of coccyx cysts and epithelial coccygeal passage – only operative.The essence of the operation is reduced to staining the course with a dye and its radical excision. The wound in the coccygeal region is sutured with special sutures (video 1).
Video 1. Stages of surgical treatment of epithelial fistulous tract (from our own practice).
For this, before surgery, it is necessary to make an examination of the rectum, pelvic organs and X-ray examination of bones and fistulous tract.Much attention should be paid to both the complete removal of the fistulous tract and the correct healing of the postoperative wound.
A congenital pathology of the development of soft tissues in the sacral region is quite common – the epithelial coccygeal passage.This disease in most cases is asymptomatic, and only if there is inflammation, patients go to the doctor. This pathology is most often seen in young men, most likely due to increased hair growth in this area. According to ICD 10, the disease is called a pilonidal cyst or pilonidal sinus. You can also find such designations of this condition as coccygeal fistula, coccyx cyst, epithelial coccygeal cyst. This is a congenital pathology and is characterized by the presence of a narrow channel in the subcutaneous tissue in the area of the intergluteal fold.Usually this course looks like a narrow tube 2-3 centimeters long, and is directed towards the coccyx. But the canal is not connected with bone tissue, but ends blindly in the subcutaneous tissue. Inside it is the epithelium with hair follicles, sebaceous and sweat glands. The other end of the epithelial coccygeal passage opens with one or more holes just above the anus, usually between or just above the buttocks. According to these signs, three types of pilonidal cysts are distinguished: uncomplicated, which may not manifest itself in any way throughout a person’s life, acute and chronic inflammation.Suppuration of the canal goes through the stages of infiltration and abscess. If the abscess opens on its own, a secondary opening of the coccygeal passage forms. This usually leads to chronic inflammation. Then the suppuration recurs, causing the formation of fistulas.
Reasons for occurrence:
There are now two theories regarding the cause of this defect. Most scientists believe that this is a congenital pathology.Such a channel is formed even in the process of intrauterine development. The rudimentary tail, which is present in all embryos up to 5 weeks, for some reason remains in the form of a tube lined with epithelium inside. Such a defect occurs in newborns quite often. But abroad, doctors identify other causes of pathology. Due to the fact that inflammation is very rare in a child, and most often such a defect develops with increased hair growth in the intergluteal region, it is called a hair cyst.It is believed that it appears due to abnormal growth or ingrowth of hair into the skin of the gluteal fold.
The only symptom may be a fossa or small holes in the gluteal fold.Only when hair growth begins, the active work of the sebaceous and sweat glands, certain signs of the disease may appear. This is most often a slight itching, discharge from the primary openings, increased humidity in the intergluteal fold, sometimes a bundle of hair grows from the canal. A suppurative epithelial passage has more pronounced symptoms. But patients often mistake them for the consequences of trauma, therefore, the correct treatment of the disease does not always begin on time. The following symptoms indicate the presence of inflammation:
1.Pain in the coccyx and sacrum, especially worse when sitting;
2. the skin around the canal becomes dense, redness and swelling are noticeable;
3. There is a discharge of ichor, and then pus from the holes of the passage;
4. Chronic, recurrent abscess occurs without treatment;
5. fistulas appear;
The only effective treatment for ECH is surgery.The operation is performed according to two methods: radical or palliative. In the first case, the surgeon completely removes the walls of the passage with the primary and secondary holes and the inflamed tissue adjacent to the passage, then sutures. In the second, the abscess is opened and drained. Radical removal is performed in a planned manner in the absence of acute inflammatory processes (uncomplicated form of ECC). The palliative method provides for the treatment of the epithelial coccygeal passage in two stages: curing abscess, abscesses by opening or local excision with subsequent removal general inflammation, then – the appointment of a planned radical surgery.In the proctology department of the Road Clinical Hospital at st. Irkutsk-Passenger uses surgical techniques aimed at the fastest possible rehabilitation of patients in the postoperative period. In the case of an uncomplicated form of the epithelial coccygeal passage, an operation is used – sinusectomy with the SURGITRON apparatus. The advantage of this type of surgical intervention is to minimize surgical trauma, the absence of deformation of the soft tissues of the intergluteal fold, which in turn leads to early rehabilitation and a good cosmetic result.For complicated secondary fistulas and recurrent forms of the epithelial coccygeal passage, the department uses a technique with excision of soft tissues in the intergluteal fold containing a fistula and the passage itself with plastic replacement of the soft tissue defect (Limberg plastic). This technique prevents the recurrence of the disease and provides a good functional result in comparison with traditional methods of surgical treatment.
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