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  • • Acute, chronic, recurring abscess or chronic draining sinus over the sacrococcygeal or perianal region

    • An acquired infection of natal cleft hair follicles that become distended and obstructed and rupture into the subcutaneous tissues to form a pilonidal abscess

    • Hair from the surrounding skin is pulled into the abscess cavity by the friction generated by the gluteal muscles during walking

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Epidemiology

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  • • Incidence of pilonidal disease is highest in white males (3:1 male:female ratio) between ages 15 and 40 with a peak incidence between 16 and 20 years

    • Most common in the hirsute, moderately obese patient

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Symptoms and Signs

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  • • Pain, fluctuant mass

    • Tenderness

    • Purulent drainage

    • Inspissated hair

    • Induration

    • Patients may present with small midline pits or abscesses on or off the midline near the coccyx or sacrum

    • Physical exam may reveal a spectrum of disease from acute suppuration and an undrained abscess or chronic draining sinuses with multiple mature tracts with hairs protruding from the pit-like openings

    • Most sinus tracts run cephalad

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Laboratory Findings

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  • • No specific findings

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  • • Cryptoglandular abscess

    • Fistula-in-ano

    • Hidradenitis suppurativa

    • Furuncle

    • Actinomycosis

    • Tuberculous granuloma

    • Osteomyelitis with draining sinuses

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  • • History and physical exam

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Surgery

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  • • Pilonidal abscesses may be drained under local anesthesia

    • Probe may be inserted into the primary opening and the abscess unroofed

    • Granulation tissue and inspissated hair are pulled out

    • Excision of midline pits with removal of hair from lateral tract

    • Excision with open packing, marsupialization, or primary closure with or without flaps

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Medications

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  • • Antibiotics usually not indicated

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Complications

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  • • Untreated pilonidal disease may result in multiple draining sinuses with chronic recurrent abscess, drainage, soiling of clothing, and, rarely, necrotizing wound infections or malignant degeneration

    • Carcinoma arising from chronic pilonidal sinus is rare, usually well-differentiated squamous cell carcinoma

    • -Treatment is wide excision

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Prognosis

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  • • Cure rates of 60-80% have been reported after primary unroofing and extraction of hair

    • Conservative excision of midline pits with removal of hair from lateral tracts and postoperative weekly shaving has 90% success rate

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Prevention

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  • • Meticulous skin care (shaving of natal cleft)

    • Perineal hygiene, wound cleansing

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References

Akinci OF et al: Simple and effective surgical treatment of pilonidal sinus: asymmetric excision and primary closure using suction drain and subcuticular skin closure. Dis Colon Rectum 2000;43:701.  [PubMed: 10826434]
McCallum I et al: Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Cochrane Database Syst Rev 2007;4:CD006213
Peterson S et al: Primary closure techniques in chronic pilonidal sinus: a survey of the results of different ...

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