Pilonidal Abscess Flashcards
What Dx / Tx
(1) Sudden onset of mild-to-severe pain in the intergluteal region while sitting or stretching the skin overlying the natal cleft +/- swelling with mucoid, purulent, and/or bloody drainage in the area.
(2) The ingrown hairs may become infected and present acutely as an abscess in the sacrococcygeal region.
(3) Typical are normal skin flora, with Staphylococcus species being the most common. Contamination with peritoneal and fecal organisms is also possible.
(4) Clinical hallmark is a tender, swollen, and fluctuant nodule located along the superior gluteal fold.
Acute Pilonidal Abscess
(a) An acute pilonidal abscess is managed with prompt incision and drainage at the time of presentation.
-1) Incise over the area of maximal fluctuance, and remove/debride all inflammatory debris & visible hair within the abscess cavity should be debrided. Wounds are packed with gauze, and healing occurs by secondary intention in the acute setting.
(b) Antibiotic use should be reserved for those with cellulitis in the absence of abscess, or in those with an abscess and significant cellulitis after surgical drainage.
What Dx / Tx
(1) Although the etiology is unknown, it is speculated that the cleft creates a suction that draws hair into the midline pits when a patient sits.
(2) For asymptomatic patients, the physical examination reveals one or more primary pores (pits) in the midline of the natal cleft and/or a painless sinus opening.
(3) In asymptomatic pilonidal disease, there is no acute inflammation or infection.
(4) The patient may not even be aware of the sinus tract formation.
Asymptomatic Pilonidal Disease
-Surgical excision is not typically performed for patients without an acute flare of a pilonidal sinus. Surgery should be discouraged in the asymptomatic patient.
Differential Diagnosis Pilonidal Abscess
(1) Perianal abscess
(2) Folliculitis
(3) Furuncle
(4) Carbuncle
Pilonidal Abscess Complications
(1) Systemic infection
(2) Recurrence
