eMedicine Specialties > General Surgery > Colorectal

Pilonidal Disease: Workup

Author: James de Caestecker, DO, Instructor, Department of Surgery, MCP Hahnemann University
Coauthor(s): Barry D Mann, MD, Program Director, Associate Professor, Department of Surgery, Division of General Surgery, MCP Hahnemann University; Andres E Castellanos, MD, Assistant Professor, Associate Surgical Residency Program Director, Department of Surgery, Drexel University College of Medicine; Jason Straus, MD, Staff Physician, Department of Surgery, Wright State University School of Medicine
Contributor Information and Disclosures

Updated: Aug 24, 2009

Workup

Histologic Findings

After the onset of puberty, sex hormones affect the pilosebaceous glands, and subsequently, the hair follicle becomes distended with keratin. As a result, a folliculitis develops that produces edema and follicle occlusion. The infection tracks away from the surface in the trajectory of the occluded follicle. This usually places the tracking follicle approximately 5-8 cm from the anus. In the rarer instance that the sinus is located caudally, it is usually found 4-5 cm from the anus. The laterally communicating sinus overlying the sacrum is created as the pilonidal abscess spontaneously drains to the skin surface. The original sinus tract from the natal cleft becomes an epithelialized tube. The laterally draining tract becomes a granulating sinus tract opening.

More on Pilonidal Disease

Overview: Pilonidal Disease
Workup: Pilonidal Disease
Treatment: Pilonidal Disease
Follow-up: Pilonidal Disease
References
Further Reading
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References

  1. Doll D, Friederichs J, Dettmann H, et al. Time and rate of sinus formation in pilonidal sinus disease. Int J Colorectal Dis. Apr 2008;23(4):359-64. [Medline].

  2. Clothier PR, Haywood IR. The natural history of the post anal (pilonidal) sinus. Ann R Coll Surg Engl. May 1984;66(3):201-3. [Medline]. [Full Text].

  3. Akinci OF, Bozer M, Uzunkoy A, et al. Incidence and aetiological factors in pilonidal sinus among Turkish soldiers. Eur J Surg. Apr 1999;165(4):339-42. [Medline].

  4. Taylor BA, Hughes LE. Circumferential perianal pilonidal sinuses. Dis Colon Rectum. Feb 1984;27(2):120-2. [Medline].

  5. Stansby G, Greatorex R. Phenol treatment of pilonidal sinuses of the natal cleft. Br J Surg. Jul 1989;76(7):729-30. [Medline].

  6. Zimmerman CE. Outpatient excision and primary closure of pilonidal cysts and sinuses. Am J Surg. Nov 1978;136(5):640-2. [Medline].

  7. Lund JN, Leveson SH. Fibrin glue in the treatment of pilonidal sinus: results of a pilot study. Dis Colon Rectum. May 2005;48(5):1094-6. [Medline].

  8. Gupta PJ. Radiofrequency sinus excision: better alternative to marsupialization technique in sacrococcygeal pilonidal sinus disease. J Natl Med Assoc. Jul 2005;97(7):998-1002. [Medline].

  9. Allen-Mersh TG. Pilonidal sinus: finding the right track for treatment. Br J Surg. Feb 1990;77(2):123-32. [Medline].

  10. Farringer JL Jr, Pickens DR Jr. Pilonidal cyst: an operative approach. Am J Surg. Feb 1978;135(2):262-4. [Medline].

  11. Sondenaa K, Nesvik I, Andersen E, et al. Recurrent pilonidal sinus after excision with closed or open treatment: final result of a randomised trial. Eur J Surg. Mar 1996;162(3):237-40. [Medline].

  12. Spivak H, Brooks VL, Nussbaum M, et al. Treatment of chronic pilonidal disease. Dis Colon Rectum. Oct 1996;39(10):1136-9. [Medline].

  13. Solla JA, Rothenberger DA. Chronic pilonidal disease. An assessment of 150 cases. Dis Colon Rectum. Sep 1990;33(9):758-61. [Medline].

  14. Abu Galala KH, Salam IM, Abu Samaan KR, et al. Treatment of pilonidal sinus by primary closure with a transposed rhomboid flap compared with deep suturing: a prospective randomised clinical trial. Eur J Surg. May 1999;165(5):468-72. [Medline].

  15. Mahdy T. Surgical treatment of the pilonidal disease: primary closure or flap reconstruction after excision. Dis Colon Rectum. Dec 2008;51(12):1816-22. [Medline].

  16. Basterzi Y, Canbaz H, Aksoy A, et al. Reconstruction of extensive pilonidal sinus defects with the use of S-GAP flaps. Ann Plast Surg. Aug 2008;61(2):197-200. [Medline].

  17. Ersoy E, Onder Devay A, Aktimur R, et al. Comparison of the short-term results after Limberg and Karydakis procedures for pilonidal disease: randomized prospective analysis of 100 patients. Colorectal Dis. Jul 15 2008;[Medline].

  18. Kulacoglu H. Choosing the correct side for Karydakis flap. Colorectal Dis. Nov 2008;10(9):949-50. [Medline].

  19. [Best Evidence] Spyridakis M, Christodoulidis G, Chatzitheofilou C, et al. The role of the platelet-rich plasma in accelerating the wound-healing process and recovery in patients being operated for pilonidal sinus disease: preliminary results. World J Surg. Aug 2009;33(8):1764-9. [Medline].

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Further Reading

Related eMedicine topics:
 Advancement Flaps [Dermatology]
Advancement Flaps [Otolaryngology and Facial Plastic Surgery]
Flaps, Classification
Flaps, Fasciocutaneous Flaps
Flaps, Free Tissue Transfer
Flaps, Muscle and Musculocutaneous Flaps
Flaps, Random Skin Flaps
Hidradenitis Suppurativa [Dermatology]
Hidradenitis Suppurativa [Emergency Medicine]
Hidradenitis Suppurativa [General Surgery]
Pilonidal Cyst and Sinus
Rhombic Flaps
Rotation Flaps [Dermatology]
Rotation Flaps [Otolaryngology and Facial Plastic Surgery]

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Keywords

pilonidal disease, pilonidal, pilonidal cyst, pilonidal cysts, pilonidal abscess, pilonidal sinus, skin flap, advancement flap, pilonidal surgery, pilonidal treatment, sacrococcygeal pilonidal sinus, natal cleft cyst, sinus pilonidal disease, pilonidal sinus disease, endoanal pilonidal sinus, perianal pilonidal disease

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Contributor Information and Disclosures

Author

James de Caestecker, DO, Instructor, Department of Surgery, MCP Hahnemann University
James de Caestecker, DO is a member of the following medical societies: American College of Surgeons
Disclosure: Nothing to disclose.

Coauthor(s)

Barry D Mann, MD, Program Director, Associate Professor, Department of Surgery, Division of General Surgery, MCP Hahnemann University
Barry D Mann, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for Cancer Education, American College of Surgeons, American Society of Bariatric Physicians, Association for Surgical Education, Society for Surgery of the Alimentary Tract, and Society of Surgical Oncology
Disclosure: Nothing to disclose.

Andres E Castellanos, MD, Assistant Professor, Associate Surgical Residency Program Director, Department of Surgery, Drexel University College of Medicine
Andres E Castellanos, MD is a member of the following medical societies: American College of Surgeons
Disclosure: Sanofi-adventis Consulting fee Consulting

Jason Straus, MD, Staff Physician, Department of Surgery, Wright State University School of Medicine
Jason Straus, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, and Society of American Gastrointestinal and Endoscopic Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Oscar Joe Hines, MD, Assistant Professor, Department of Surgery, University of California at Los Angeles School of Medicine
Oscar Joe Hines, MD is a member of the following medical societies: Alpha Omega Alpha, American Association of Endocrine Surgeons, American College of Surgeons, Association for Academic Surgery, Society for Surgery of the Alimentary Tract, and Society of American Gastrointestinal and Endoscopic Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

David L Morris, MD, PhD, Professor, Department of Surgery, St George Hospital, University of New South Wales, Australia
Disclosure: RFA Medical None Director; MRC Biotec None Director

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA, Vice Chairman, Professor, Department of Surgery, Section of Gastrointestinal Medicine and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital
John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract
Disclosure: AMGEN Royalty Other

 
 
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