Pilonidal Cyst and Sinus Clinical Presentation

  • Author: Michael D Lanigan, MD; Chief Editor: Pamela L Dyne, MD   more...
 
Updated: Apr 16, 2012
 

History

Pilonidal disease can present in a couple of different disease states, but the most common seen in the ED is a painful, swollen lesion in the sacrococcygeal region about 4-5 cm posterior to the anal orifice. At times, spontaneous drainage may have occurred prior to presentation to the clinician.

Occasionally, a history of trauma is recalled, and the patient may state that a similar lesion occurred in that area before, for which the patient may have had a primary incision and drainage or other definitive care prior to this presentation.[5] Given most patients are young and healthy, other comorbidities are not common, and review of systems is often negative, including fever and chills.

There is no known preponderance of this disease in smokers or alcohol or drug abusers.

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Physical

Usually, the patient is afebrile and nontoxic. Local examination may show a relatively unremarkable sinus tract in the sacrococcygeal region, but, usually at ED presentation, the patient has typical findings of an abscess, including redness, warmth, local tenderness, and fluctuance with or without induration. Loose hair may be seen projecting from the site.[6, 3]

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Causes

  • Pilonidal disease involves loose hair and skin and perineal flora.
    • Risk factors for pilonidal disease include male gender, hirsute individuals, Caucasians, sitting occupations, existence of a deep natal cleft, and presence of hair within the natal cleft. Family history is seen in 38% of patients with pilonidal disease. Obesity is a risk factor for recurrent disease.
    • The most commonly reported bacteria cultured from pilonidal abscesses differ by author. In one study, anaerobic cocci were present 77% of the time; aerobic, 4%; and mixed aerobic and anaerobic, 17%. Other studies quote Staphylococcus aureus, an aerobe, as being the most common bacterial pathogen.
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Contributor Information and Disclosures
Author

Michael D Lanigan, MD  Attending Physician, Department of Emergency Medicine, Administrative Section, State University of New York Downstate, Brooklyn

Michael D Lanigan, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Jerry Balentine, DO  Professor of Emergency Medicine, New York College of Osteopathic Medicine; Executive Vice President, Chief Medical Officer, Attending Physician in Department of Emergency Medicine, St Barnabas Hospital

Jerry Balentine, DO is a member of the following medical societies: American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, American College of Physician Executives, American Osteopathic Association, and New York Academy of Medicine

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

Jeter (Jay) Pritchard Taylor III, MD  Compliance Officer, Attending Physician, Emergency Medicine Residency, Department of Emergency Medicine, Palmetto Health Richland, University of South Carolina School of Medicine; Medical Director, Department of Emergency Medicine, Palmetto Health Baptist

Jeter (Jay) Pritchard Taylor III, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Pamela L Dyne, MD  Professor of Clinical Medicine/Emergency Medicine, University of California, Los Angeles, David Geffen School of Medicine; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center

Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Robert Ringelheim, MD, Mark A Silverberg, MD, and Norma Jean Johnson-Villanueva, MD, to the development and writing of this article.

References

  1. Hull TL, Wu J. Pilonidal disease. Surg Clin North Am. Dec 2002;82(6):1169-85. [Medline].

  2. da Silva JH. Pilonidal cyst: cause and treatment. Dis Colon Rectum. Aug 2000;43(8):1146-56. [Medline].

  3. Miller D, Harding K. Pilonidal Sinus Disease. Dec 2003. World Wide Wounds. Available at http://www.worldwidewounds.com/2003/december/Miller/Pilonidal-Sinus.html.

  4. Ghnnam WM, Hafez DM. Laser hair removal as adjunct to surgery for pilonidal sinus: our initial experience. J Cutan Aesthet Surg. Sep 2011;4(3):192-5. [Medline]. [Full Text].

  5. Caestecker J, Mann BD, Castellanos AE, Straus J. Pilonidal Disease. eMedicine from WebMD. Last updated Jan 22, 2009. [Full Text].

  6. Burnstein M. Managing anorectal emergencies. Can Fam Physician. Aug 1993;39:1782-5. [Medline].

  7. von Laffert M, Stadie V, Ulrich J, Marsch WC, Wohlrab J. Morphology of pilonidal sinus disease: some evidence of its being a unilocalized type of hidradenitis suppurativa. Dermatology. 2011;223(4):349-55. [Medline].

  8. Feigen GM, Gordon RB. Pilonidal disease simulating rectal abscess and fistula. AMA Arch Surg. Aug 1956;73(2):258-60. [Medline].

  9. Hoffman NN, Hoffman GH, Firoozmand E, Capiendo LM. Pilonidal Disease: Subtle, Not So Subtle and Stubborn. Los Angeles Colon and Rectal Surgical Associates. Available at https://www.lacolon.com/documents/Pilonidal%20Disease.pdf.

  10. Doll D, Friederichs J, Boulesteix AL, Dusel W, Fend F, Petersen S. Surgery for asymptomatic pilonidal sinus disease. Int J Colorectal Dis. Sep 2008;23(9):839-44. [Medline].

  11. McCallum I, King PM, Bruce J. Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Cochrane Database Syst Rev. Oct 17 2007;CD006213. [Medline].

 
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