Pilonidal Disease Workup

  • Author: James de Caestecker, DO; Chief Editor: John Geibel, MD, DSc, MA   more...
 
Updated: Jan 6, 2012
 

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.

Proceed to Treatment & Management
 
 
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: Nothing to disclose.

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.

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

David L Morris, MD, PhD, FRACS  Professor, Department of Surgery, St George Hospital, University of New South Wales, Australia

David L Morris, MD, PhD, FRACS is a member of the following medical societies: British Society of Gastroenterology

Disclosure: RFA Medical None Director; MRC Biotec None Director

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 Chair and Professor, Department of Surgery, Section of Gastrointestinal Medicine, and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director, 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 Consulting; ARdelyx Ownership interest Board membership

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. Dag A, Colak T, Turkmenoglu O, Sozutek A, Gundogdu R. Phenol procedure for pilonidal sinus disease and risk factors for treatment failure. Surgery. Jan 2012;151(1):113-7. [Medline].

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

  8. 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].

  9. 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].

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

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

  12. 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].

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

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

  15. [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].

  16. 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].

  17. 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].

  18. 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].

  19. Kaya B, Eris C, Atalay S, Bat O, Bulut NE, Mantoglu B, et al. Modified Limberg transposition flap in the treatment of pilonidal sinus disease. Tech Coloproctol. Dec 15 2011;[Medline].

  20. Kirkil C, Böyük A, Bülbüller N, Aygen E, Karabulut K, Coskun S. The effects of drainage on the rates of early wound complications and recurrences after Limberg flap reconstruction in patients with pilonidal disease. Tech Coloproctol. Dec 2011;15(4):425-9. [Medline].

  21. 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].

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

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.