Pilonidal Cyst: Symptoms, Causes, Treatment, Photo Of The Coccyx

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2024-01-15 19:51

Pilonidal cyst

The content of the article:

Characteristic
The reasons
Description
Symptoms
Complications
1. Conservative treatment
2. Surgery
Video

Pilonidal cyst (synonym - epithelial coccygeal passage) - refers to congenital anomalies in the development of the skin and subcutaneous adipose tissue. It is localized in the sacrococcygeal region (intergluteal fold). The reason for the development is incomplete infection of the rudimentary caudal ligament.

Piloidal, or coccygeal cyst is more often found in men

Characteristic

It is a narrow passage in the subcutaneous fatty tissue. Does not reach the anus and is not welded to the rectum (differential diagnosis with paraproctitis is required).
The presence of one or more inlets (the cavity is not isolated from the external environment).
In the projection of the cyst, there may be skin appendages (hair, sweat or sebaceous glands).
Correlation dependence on gender (more often occurs in men).
It has a tendency to inflammation and the onset of a purulent process.
Has a tendency to frequent relapses and the transition to a chronic process.
It may have an asymptomatic course, but there is no independent regression (resorption).
The only radical treatment is surgery.

The reasons

At the heart of the pathogenesis of the disease is a violation of the drainage of the epithelial passage (blockage of the inlets) with a gradual accumulation of waste products in its cavity. This subsequently leads to suppuration and the formation of abscesses in the sacral region.

The causes of the pilonidal cyst of the coccyx are usually divided into congenital and acquired.

Cause

Factors

Congenital (the main theory of occurrence in the Russian-language medical literature).

The disease is based on the processes of dysembryogenesis (the period of intrauterine development):

1. Theory of incomplete reduction of the muscles and ligaments of the tail.

2. Theory of ectodermal invagination. Anomaly at the level of the introduction of skin appendages into the subcutaneous fatty tissue (incorrect formation of epidermal tissue and dermis). This theory is typical for other similar pathologies with a different localization (in the armpit, honey with fingers).

3. Neurogenic theory. In this case, it is assumed that the cyst is related to the formation of the terminal section of the spinal cord (a violation in the regression of the terminal fragment).

4. The theory that connects the coccygeal passage with the coccygeal vertebrae (violation of their reverse development).

Acquired (the main theory of occurrence in the English-language medical literature).

In this case, cystic formation is regarded as a purulent-septic process. Its occurrence is based on external and internal factors:

1. Mechanical injuries (abrasions, scratches, wounds). In this case, the skin defect will be the entrance gate of the infection. Signs of suppuration do not appear immediately after infection (it has an asymptomatic course for a long time).

2. Failure to comply with hygiene rules. In newborns, diaper rash is a common cause of suppuration.

3. Specific types of profession that are associated with long-term sitting (secretary, manager, programmer).

4. Inflammatory skin diseases (dermatitis). In this case, both mechanical irritation of the skin (microdefects are formed) and the action of the causative agent of the underlying disease have an effect. If the origin of the main pathology is based on an allergic or autoimmune process, then conditionally pathogenic flora comes to the main place (it is normally localized on the skin).

5. Decreased immunity. At the same time, the skin loses its barrier and protective function (conditionally pathogenic flora leads to the development of inflammation).

6. Traumatic injury to the coccyx. In this case, the normal structure of the coccygeal passage can also be injured (change in direction, wounds, bruises), which serves as the basis for the infection.

7. Inflammation of the skin appendages (sweat or sebaceous glands, hair follicles). In this case, the inflammation of the coccygeal passage is secondary (it is based on a furuncle, carbuncle and other pustular skin diseases). With prolonged absence of treatment, the abscess can reach significant sizes and break out with the formation of a secondary fistula or inward (anorectal tissue, spinal cord with the development of meningitis).

Each theory is only an assumption about the causes of the appearance, since the exact cause has not been established.

Description

In the photo, external manifestations depend on the specific type:

pilonidal cyst with abscess L05.0;
pilonidal cyst without abscesses L05.9.

External manifestations in the first option:

hyperemia in the coccyx region (severity varies widely from slight redness to a bright red spot);
swelling of the surrounding tissues;
the contour is even, clear;
tenderness on palpation (usually pain is a very local symptom that does not affect a large number of tissues);
in some cases, a small amount of pus may be released from the holes of the stroke when pressed.

External manifestations in the second option:

skin is not treason;
slight swelling (there is no edema as such);
almost painless palpation;
contoured with dyes;
there is no discharge;
the natural openings of the cyst are visually revealed.

The different incidence and ratio of these two forms in different medical studies are given.

Symptoms

Disease variant	Clinic
Uncomplicated option (no abscess)	Dull aching pain in the coccyx. Sometimes the patient may complain of low back pain without a clear localization. The general condition is satisfactory. There are no external changes. Minor itching may occur in the intergluteal space.
Complicated variant (abscess)	Acute pain (may have a shooting character akin to pain in sciatica). Feeling of pulsation and distention in the affected area. In severe cases, the patient cannot be seated. General condition of moderate severity. All the typical symptoms of intoxication appear (fever, tachycardia, nausea / vomiting, weakness). When the abscess breaks out, fistulas form (they heal only by secondary intention and for a long time) and the patient feels relief. The symptoms gradually disappear, but the disease does not go away completely.
Chronic variant (relapses are followed by a remission phase)	The general condition is relatively satisfactory. A purulent focus does not form into a typical abscess, but immediately breaks out. This will explain the main symptom in such cysts - long-term non-healing fistulas and pronounced cicatricial changes in the affected area.

Complications

In some cases, the abscess can turn into phlegmon (diffuse purulent inflammation). This condition refers to an emergency, requires immediate hospitalization and surgery (opening and drainage of the purulent cavity).

An abscess can also burst in the direction of the spinal cord (bacteria enter the sinuses of the spinal cord and then along the ascending pathway to the brain). This leads to the development of meningitis and encephalitis with the corresponding clinical picture (an extremely formidable complication). In this case, the patient feels relief in the area of the pilonidal cyst, since it is partially drained, but the general condition deteriorates sharply, focal and cerebral symptoms occur.

Conservative treatment

The following groups of drugs are used:

Antiseptics (hydrogen peroxide, chlorhexidine) for washing and treating the affected area.
Antibiotics (Metronidazole, Cefuroxime) of local (gel, ointment) and general (tablets, i / v, i / m injections) action.
Analgesics (Ketoprofen) for pain relief.
Antifungal agents (Fluconazole) for suspected fungal infections.

Drug therapy complements surgery but is not the main treatment option.

Attention! Photo of shocking content.

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Surgery

There are several methods of surgical intervention (depending on the individual characteristics of education):

Excision of the course with suturing the wound tightly (complications in the postoperative period are no more than 20%). Position on the stomach with legs apart. Dye is injected into the holes of the stroke to reveal the structure. Next, the doctor, with a semicircular incision using a scalpel or an electric knife, excises the passage along with the skin and subcutaneous fatty tissue. The wound is sutured tightly in layers. It is permissible to use various techniques - separate interrupted seams, U-shaped.
Excision of the course with stitching the edges of the wound to the bottom (it is better to do it in the acute phase of the disease in the presence of inflammation). The same bordering incision is made as in the previous version, with the isolation of all branches of the epithelial passage. The course is removed along with the skin and subcutaneous tissue. Partially with a scalpel, the tissues of the posterior wall and the upper areas on the side walls are excised. The edges of the wound are stitched to the surface of the sacrum and coccyx in a checkerboard pattern. Extremely low risk of relapse.
Two-stage surgery. At the beginning of the operation, a puncture is performed at the site of the greatest fluctuation using a syringe. After that, the abscess is opened with a longitudinal incision. At the second stage, the coccygeal passage and its branches are partially excised within healthy tissues. The second stage is performed on the 5-7th day, when the inflammation subsides. The wound is not sutured, but lead in an open way until granulation and gradual tightening are formed.
Removal of the course with a plastic wound with a skin flap. It is used for frequent relapses and in advanced cases of the disease. Excision of the cyst with all its branches, fistulas and altered skin is performed in a single block up to and including the sacral fascia. The skin flaps are cut out at an angle to the edges of the wound, thereby ensuring good blood supply and flap mobility. The skin and subcutaneous fat are exfoliated up to the fascia. The triangular flap after displacement is fixed with separate sutures to the fascia and sutured from the caudal side. Do the same with other flaps.
Subcutaneous excision (sinusectomy). They are used more often for chronic forms in the stage of remission (a large number of leaks, cavities, secondary holes caused by fistulas). The excision begins under the skin and goes from primary to secondary passages. Mandatory staining of the course with a dye with the introduction of a special probe into its cavity. Subsequently, electrocoagulation of the course on the probe is done. Sewing is not performed.

Previously, a technique associated with opening and draining the abscess (management similar to abscesses) was used, but this method is fraught with relapses in 80% of cases.

At the moment, high-tech methods using laser surgery are increasingly used (it is a less invasive option and reduces the postoperative time of patient management).