Pilonidal Disease

Question 1

Pertinent Anatomy

Answer 1

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

Question 2

A malfunction which describes a spectrum of clinical presentations, ranging from asymptomatic _____1______ cysts and sinuses to large symptomatic abscesses of the sacrococcygeal region that have some tendency to recur. Pilonidal abscesses may occur is the presence of ______2_____which can invade through openings caused by the ingrown hairs.

Answer 2

1) hair-containing
2) Staphylococcus aureus

Question 3

Pilonidal sinuses or cysts occur in the midline in the upper part of the natal cleft overlying the _______ and _______.

Answer 3

lower sacrum and coccyx

Question 4

True/False
Pilonidal Disease is considered to be an congenital condition

Answer 4

FALSE
acquired condition

Question 5

Sinus is formed by the penetration of the skin by _________, which causes a foreign body granuloma reaction.

Answer 5

ingrowing hair

Question 6

Pilonidal disease most commonly occur before __ decade of life

Answer 6

4th

Question 7

An abscessed pilonidal cyst is always located in the _________ and does not communicate with the anorectum

Answer 7

midline
(there may however besecondary fistula openings on either side of the midline)

Question 8

What issue?
(1) The patient will generally complain of swelling, pain, or persistent discharge.
(a) When abscess formation occurs, the patient complains of a tender mass.
(2) Examination of the patient generally reveals an area of inflammation in the midline of the gluteal crease, with one or more sinus openings.
(a) The most common finding is a single opening from which hair is protruding.
(b) Spontaneous and ongoing drainage is the common indicator and if an abscess is present, it is usually small.
(3) If the patient gives a history of recurrent infection at the base of the spine, this in itself may be considered diagnostic.
(4) Patients will usually present when an abscess has formed that can no longer drain.

Answer 8

Pilonidal Disease

Question 9

Differential Diagnosis

Answer 9

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

Question 10

Lab
May consider CBC if patient demonstrates

Answer 10

systemic symptoms (fever, chills, etc.)

Question 11

The technique for incising and draining a pilonidal abscess is as follows:
(a) Place the patient in the ______ position with the buttocks retracted laterally.
(b) Tuck a chux pad between the _______ 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 ______ should be available if possible, to aspirate the unusually foul smelling 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 ______ the following day.
(h) Ensure patient follow-up within 24 hours or sooner for any concerns. The wound should be checked _______for signs of secondary infection.

Answer 11

a) prone
b) lower gluteal cleft
d) suction apparatus
g) warm sitz baths
h) daily

Question 12

True/False
Disposition
Retain onboard for uncomplicated cases. All patients should be referred to General Surgery for a more definitive management.

Answer 12

True

Question 13

What antibiotic therapy would you consider for this?

Answer 13

Cephalexin (Keflex) 500mg PO three times daily
Doxycycline 100mg BID for 7 days