PILONIDAL DISEASE Flashcards
Pertinent Anatomy of a patient with Pilonidal Disease
(1) Pilonidal Sinus
(2) Sacrum
(3) Coccyx
A malfunction which describes a spectrum of clinical presentations, ranging from
asymptomatic hair-containing cysts and sinuses to large symptomatic abscesses of the
sacrococcygeal region that have some tendency to recur
Pilonidal Disease
How to develop a pilonidal disease
Sinus is formed by the penetration of the skin by ingrowing hair, which causes a foreign
body granuloma reaction.
Considered to be an acquired condition
Pilonidal sinuses or cysts occur where
in the midline in the upper part of the natal cleft
overlying the lower sacrum and coccyx.
Most commonly occur before the ___ decade of life
4th
An abscessed pilonidal cyst is always located in the midline (there may however be
secondary fistula openings on either side of the midline) and does not communicate with
the anorectum
just read this
The patient will generally complain of
swelling, pain, or persistent discharge.
When abscess formation occurs, the patient complains of a tender mass.
Examination reveals
an area of inflammation in the midline of the
gluteal crease, with one or more sinus openings
The most common finding
a single opening from which hair is protruding.
what is the common indicator
Spontaneous and ongoing drainage is the common indicator and if an abscess is
present, it is usually small.
If the patient gives a history of recurrent infection at the base of the spine, this in itself
may be considered
diagnostic
Patients will usually present when
an abscess has formed that can no longer drain.
Differential Diagnosis
(1) Perirectal abscess
(2) Local infection
(3) Epidermal inclusion cyst
(4) Cellulitis
Lab
May consider CBC if patient demonstrates systemic symptoms (fever, chills, etc.)
treatment of choice
Surgical treatment
Surgical treatment should be performed for the following:
(a) Acute Abscess formation in the superior gluteal crease area a simple incision and
drainage [I&D] is typically adequate. Recurrences are common.
(b) Patients with a history of recurrent infections and drainage at the base of the spine
are better treated with complete excision of the area. This is typically performed at
least 6 weeks after any active infection, to allow their wounds to heal prior to
definitive surgical excision
Patients need to be informed of prolonged healing times due to leaving the wound open
to heal by
secondary intention
An open wound should be cleaned
daily with soap and water by showering or other
irrigation.
During early stages of wound healing, the wound is packed with a ____, changed daily (a “wet to dry” dressing)
a moistened gauze
sponge
The technique for incising and draining a pilonidal abscess is as follows
(a) Place the patient in the prone position with the buttocks retracted laterally.
(b) Tuck a chux pad between the lower gluteal cleft to prevent the prep solution from
pooling at the anus or genitals.
(c) After having prepped the skin, infiltrate the area to be incised with an intradermal
injection of anesthetic solution (%1 or 2% Lidocaine), using a fine-gauge needle.
(d) A suction apparatus should be available if possible, to aspirate the unusually foulsmelling pus that has accumulated within the abscess.
(e) Following drainage, gently break down any loculations that may be present, irrigate
the wound thoroughly, and loosely pack the wound with sterile or iodoform gauze.
(Use only 1 piece and take note of the amount used)
(f) A bulk dressing should be applied and secured with tape to the patient’s buttocks.
(g) Provide strong oral analgesics and be advised to start warm sitz baths the following
day.
(h) Ensure patient follow-up within 24 hours or sooner for any concerns. The wound
should be checked daily for signs of secondary infection.
Antibiotic therapy should be considered only as ____ and ____ because
recurrence will be the rule until adequate I&D or excision is accomplished
temporizing and palliative
Antibiotics
may also be considered in addition to I&D when
if surrounding cellulitis is present
which antibiotics
(a) Cephalexin (Keflex) - is a 1st generation Cephalosporin antibiotic
1) Dose: 500mg PO three times daily (TID)
(b) Doxycycline is in the Tetracycline family of antibiotics
1) Dose: 100mg BID for 7 days
Disposition
(a) Disposition: A MEDADVICE message should be sent for patients presenting with
this condition.
(b) MEDEVAC may be required
Initial Care
Incision and drainage with suction in more complicated cases refer to general surgery
