- Pilonidal cyst
A pilonidal cyst, also referred as sacrococcygeal fistula, is a
cyst near thenatal cleft of the buttocks that often contains hair and skin debris.Etymology
Pilonidal means "nest of hair", and is derived from the Latin words for hair ("pilus") and nest ("nidus"). [http://www.mayoclinic.com/health/pilonidal-cyst/DS00747 Pilonidal cyst] from the Mayo Clinic.] The term was used by
Herbert Mayo as early as 1830.cite web |url=http://www.emedicine.com/emerg/topic771.htm |title=eMedicine - Pilonidal Cyst and Sinus : Article by Robert Ringelheim, MD |accessdate=2007-11-18 |format= |work=] cite web |url=http://www.ispub.com/ostia/index.php?xmlPrinter=true&xmlFilePath=journals/ijs/vol11n1/vacuum.xml |title=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 |accessdate=2007-11-18 |format= |work=] [Mayo H. Observations on injuries and diseases of the rectum. London: Burgess & Hill, 1833] R.M. Hodges was the first to use the phrase "pilonidal cyst" to describe the condition in 1880. [Hodges RM, Pilo-nidal sinus. Boston Med Surg J 1880; 103:485] cite book |author=Elsner, Peter |title=Handbook of Occupational Dermatology |publisher=Springer |location=Berlin |year=2000 |pages= 821 |isbn=3-540-64046-0 |oclc= |doi=]Presentation
Pilonidal cysts can be painful, afflict men more frequently than women, and typically occur between the ages of 15 and 24. Although usually found near the tailbone, the condition can also affect the
navel ,armpit orpenis , [cite journal |last=Rao |first=A.R. |coauthors=M. Sharma, M. Thyveetil and O.M. Karim |year=2006 |title=Penis: an unusual site for pilonidal sinus |journal=International Urology and Nephrology |volume=38 |issue=3-4 |pages=607-608 |pmid=17111086 ] though these locations are much more rare.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 if it is draining, the patient might not feel pain.Causes
One proposed cause of pilonidal cysts is
ingrown hair .cite web |url=http://www.mayoclinic.com/health/pilonidal-cyst/DS00747/DSECTION=3 |title=Pilonidal cyst. Mayo Clinic |accessdate=2008-02-13 |format= |work=] Obesity and excessive sitting are thought to predispose people to the condition because they increase pressure on thecoccyx region. Trauma is not believed to cause a pilonidal cyst, however such an event may inflame 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.cite journal |author=da Silva JH |title=Pilonidal cyst: cause and treatment |journal=Dis. Colon Rectum |volume=43 |issue=8 |pages=1146–56 |year=2000 |pmid=10950015 |doi=] Sweating or excessive sweating can also contribute to the cause of a pilonidal cyst.The condition was widespread in
United States Army duringWorld War II . More than eighty thousand soldiers having the condition required hospitalization.cite web |url=http://dermnetnz.org/acne/pilonidal-sinus.html |title=Pilonidal disease. DermNet NZ |accessdate=2007-11-18 |format= |work=] 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 caused the condition due to irritation and pressure on the tailbone.Treatment
Treatment may include
antibiotic therapy, hot compresses and application ofdepilatory 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 . [ [http://openurl.ingenta.com/content?genre=article&issn=1462-8910&volume=1&issue=2&spage=107&epage=110 Prolonged delay in healing after surgical treatment of pilonidal sinus is avoidable] ]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. [ [http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijs/vol8n1/pns.xml Pilonidal Sinus And Prolonged Sexual Stimulation] ]
The condition has a 40% chance of recurrence, even after surgery.Fact|date=August 2008 Recurrence is greater 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 ofteratoma (germ cell tumor ). In particular, a pilonidal cyst in thegluteal cleft can resemble asacrococcygeal teratoma . Correct diagnosis is important because allteratoma s require complete surgical excision, if possible without any spillage, and consultation with anoncologist .References
External links
* [http://www.pilonidal.org/ Pilonidal.org] – Pilonidal Support Alliance
* [http://www.mckinley.uiuc.edu/handouts/pilonidal%5Fdisease.html Pilonidal Disease]
* [http://www.worldwidewounds.com/2003/december/Miller/Pilonidal-Sinus.html World Wide Wounds] - in-depth information on the treatment and symptoms of the condition, with photographs.
* [http://www.nhsdirect.nhs.uk/articles/article.aspx?articleID=285 Pilonidal sinus] – NHS Direct Online Health Encyclopaedia
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