Pilonidal cyst: Wikis

  

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Pilonidal cyst
Classification and external resources

Two pilonidal cysts that have formed in the gluteal cleft of an adult male.
ICD-10 L05.
ICD-9 685
DiseasesDB 31128
eMedicine emerg/771
MeSH D010864

A pilonidal cyst, also referred to as a pilonidal abscess, pilonidal sinus or sacrococcygeal fistula, is a cyst or abscess near or on the natal cleft of the buttocks that often contains hair and skin debris.[1][2]

Contents

Etymology

Pilonidal means "nest of hair", and is derived from the Latin words for hair ("pilus") and nest ("nidus").[1] The term was used by Herbert Mayo as early as 1830.[3][4][5] R.M. Hodges was the first to use the phrase "pilonidal cyst" to describe the condition in 1880.[6][7]

Presentation

Pilonidal cysts are quite painful, affect men more frequently than women, and typically occur between the ages of 15 and 24.[1] Although usually found near the coccyx, the condition can also affect the navel, armpit or penis,[8] though these locations are much more rare.

Some people with a pilonidal cyst will be asymptomatic.[9]

Pilonidal sinus

A sinus tract, or small channel, may originate from the source of infection and open to the surface of the skin. Material from the cyst may drain through the pilonidal sinus. A pilonidal cyst is usually painful, but with draining, the patient might not feel pain.

Causes

One proposed cause of pilonidal cysts is ingrown hair.[10] Excessive sitting is thought to predispose people to the condition because they increase pressure on the coccyx region. Trauma is not believed to cause a pilonidal cyst; however, such an event may result in inflammation of an existing cyst. However there are cases where this can occur months after a localized injury to the area. Some researchers have proposed that pilonidal cysts may be the result of a congenital pilonidal dimple.[11] Excessive sweating can also contribute to the cause of a pilonidal cyst.

The condition was widespread in the United States Army during World War II. More than eighty thousand soldiers having the condition required hospitalization.[12] It was termed "Jeep riders' disease," because a large portion of people who were being hospitalized for it rode in jeeps, and prolonged rides in the bumpy vehicles were believed to have caused the condition due to irritation and pressure on the coccyx.

Treatment

Treatment may include antibiotic therapy, hot compresses and application of depilatory creams.

In more severe cases, the cyst may need to be lanced or surgically excised (along with pilonidal sinus tracts). Post-surgical wound packing may be necessary, and packing typically must be replaced twice daily for 4 to 8 weeks. In some cases, 1 year may be required for complete granulation to occur. Sometimes the cyst is resolved via surgical marsupialisation.[13]

Surgeons can also excise the sinus and repair with a reconstructive flap technique, which is done under general anesthetic. This approach is mainly used for complicated or recurring pilonidal disease, leaves little scar tissue and flattens the region between the buttocks, reducing the risk of recurrence.[14]

A novel and less destructive treatment is scraping the tract out and filling it with fibrin glue. This has the advantage of causing much less pain than traditional surgical treatments and allowing return to normal activities after 1-2 days in most cases.[15]

Pilonidal cysts recur and do so more frequently if the surgical wound is sutured in the midline, as opposed to away from the midline, which obliterates the natal cleft and removes the focus of shearing stress.

Differential diagnosis

A pilonidal cyst can resemble a dermoid cyst, a kind of teratoma (germ cell tumor). In particular, a pilonidal cyst in the gluteal cleft can resemble a sacrococcygeal teratoma. Correct diagnosis is important because all teratomas require complete surgical excision, if possible without any spillage, and consultation with an oncologist.

Famous sufferers

  • Dallas Jackson [17]

References

  1. ^ a b c Pilonidal cyst from the Mayo Clinic.
  2. ^ "The So-Called Pilo-Nidal Sinus." Klass, AA (1956). Can Med Assoc J. Nov 1; 75(9)
  3. ^ "eMedicine - Pilonidal Cyst and Sinus : Article by Robert Ringelheim, MD". http://www.emedicine.com/emerg/topic771.htm. Retrieved 2007-11-18. 
  4. ^ "The use of Wound Vacuum-assisted Closure (V.A.C.) system in the treatment of Recurrent or Complex Pilonidal Cyst Disease: Experience in 4 Adolescent Patients". http://www.ispub.com/ostia/index.php?xmlPrinter=true&xmlFilePath=journals/ijs/vol11n1/vacuum.xml. Retrieved 2007-11-18. 
  5. ^ Mayo H. Observations on injuries and diseases of the rectum. London: Burgess & Hill, 1833
  6. ^ Hodges RM, Pilo-nidal sinus. Boston Med Surg J 1880; 103:485
  7. ^ Elsner, Peter (2000). Handbook of Occupational Dermatology. Berlin: Springer. pp. 821. ISBN 3-540-64046-0. 
  8. ^ Rao, A.R.; M. Sharma, M. Thyveetil and O.M. Karim (2006). "Penis: an unusual site for pilonidal sinus". International Urology and Nephrology 38 (3-4): 607–608. doi:10.1007/s11255-005-4761-5. PMID 17111086. 
  9. ^ Doerr, Steven E. MD (2008-09-08), Pilonidal cyst. EMedicine Health.com. (accessed 2009-03-04)
  10. ^ "Pilonidal cyst. Mayo Clinic". http://www.mayoclinic.com/health/pilonidal-cyst/DS00747/DSECTION=3. Retrieved 2008-02-13. 
  11. ^ da Silva JH (2000). "Pilonidal cyst: cause and treatment". Dis. Colon Rectum 43 (8): 1146–56. PMID 10950015. 
  12. ^ "Pilonidal disease. DermNet NZ". http://dermnetnz.org/acne/pilonidal-sinus.html. Retrieved 2007-11-18. 
  13. ^ Prolonged delay in healing after surgical treatment of pilonidal sinus is avoidable
  14. ^ Pilonidal Sinus And Prolonged Sexual Stimulation
  15. ^ Fibrin glue in the treatment of pilonidal sinus: results of a pilot study. Lund JN, Leveson SH.Dis Colon Rectum. 2005 May;48(5):1094-6.
  16. ^ "Rush Limbaugh's Pilonidal Cyst". http://www.snopes.com/military/limbaugh.asp. Retrieved August 21, 2009. 
  17. ^ "Should I Go To The Emergency Room". http://www.the-mainboard.com/forum/index.php/topic,54914.30.html. Retrieved March 17, 2009. 

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