PILONIDAL DISEASE

Question 1

Pertinent Anatomy of a patient with Pilonidal Disease

Answer 1

(1) Pilonidal Sinus
(2) Sacrum
(3) Coccyx

Question 2

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

Answer 2

Pilonidal Disease

Question 3

How to develop a pilonidal disease

Answer 3

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

Question 4

Pilonidal sinuses or cysts occur where

Answer 4

in the midline in the upper part of the natal cleft

overlying the lower sacrum and coccyx.

Question 5

Most commonly occur before the ___ decade of life

Answer 5

4th

Question 6

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

Answer 6

just read this

Question 7

The patient will generally complain of

Answer 7

swelling, pain, or persistent discharge.

When abscess formation occurs, the patient complains of a tender mass.

Question 8

Examination reveals

Answer 8

an area of inflammation in the midline of the

gluteal crease, with one or more sinus openings

Question 9

The most common finding

Answer 9

a single opening from which hair is protruding.

Question 10

what is the common indicator

Answer 10

Spontaneous and ongoing drainage is the common indicator and if an abscess is
present, it is usually small.

Question 11

If the patient gives a history of recurrent infection at the base of the spine, this in itself
may be considered

Answer 11

diagnostic

Question 12

Patients will usually present when

Answer 12

an abscess has formed that can no longer drain.

Question 13

Differential Diagnosis

Answer 13

(1) Perirectal abscess
(2) Local infection
(3) Epidermal inclusion cyst
(4) Cellulitis

Question 14

Lab

Answer 14

May consider CBC if patient demonstrates systemic symptoms (fever, chills, etc.)

Question 15

treatment of choice

Answer 15

Surgical treatment

Question 16

Surgical treatment should be performed for the following:

Answer 16

(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

Question 17

Patients need to be informed of prolonged healing times due to leaving the wound open
to heal by

Answer 17

secondary intention

Question 18

An open wound should be cleaned

Answer 18

daily with soap and water by showering or other

irrigation.

Question 19

During early stages of wound healing, the wound is packed with a ____, changed daily (a “wet to dry” dressing)

Answer 19

a moistened gauze

sponge

Question 20

The technique for incising and draining a pilonidal abscess is as follows

Answer 20

(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.

Question 21

Antibiotic therapy should be considered only as ____ and ____ because
recurrence will be the rule until adequate I&D or excision is accomplished

Answer 21

temporizing and palliative

Question 22

Antibiotics

may also be considered in addition to I&D when

Answer 22

if surrounding cellulitis is present

Question 23

which antibiotics

Answer 23

(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

Question 24

Disposition

Answer 24

(a) Disposition: A MEDADVICE message should be sent for patients presenting with
this condition.
(b) MEDEVAC may be required

Question 25

Initial Care

Answer 25

Incision and drainage with suction in more complicated cases refer to general surgery