Approach Considerations

Pilonidal disease is diagnosed on the basis of the history and physical examination. The typical location of the midline pits superior to the anus and overlying the sacrum and coccyx is a hallmark of the disease.^[10]Occasionally, pilonidal disease can track from a fistula around the anal canal and consequently be confused with anal fistula; however, this is rare. During physical examination, broken hairs can often be extracted from the pilonidal sinus.

Laboratory Studies

Routine laboratory data are not necessary in the treatment of pilonidal disease. Studies should be ordered if warranted by the patient’s medical history and if required for preoperative testing.

Imaging Studies

Imaging studies are not routinely obtained for pinodal disease; however, there have been reports of complicated disease progressing to osteomyelitis, necrotizing fasciitis, toxic shock syndrome, and meningitis.^[11]

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.

Treatment & Management

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Author

M Chance Spalding, DO, PhD Resident Physician, Department of General Surgery, Doctors Hospital, OhioHealth

Disclosure: Nothing to disclose.

Coauthor(s)

Jason P Straus, MD Staff Physician, Department of Surgery, Wright State University School of Medicine

Jason P Straus, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, Society of American Gastrointestinal and Endoscopic Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

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: Received none from RFA Medical for director; Received none from MRC Biotec for director.

Chief Editor

John Geibel, MD, MSc, DSc, AGAF Vice Chair and Professor, Department of Surgery, Section of Gastrointestinal Medicine, Professor, Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital; American Gastroenterological Association Fellow; Fellow of the Royal Society of Medicine

John Geibel, MD, MSc, DSc, AGAF 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, Society for Surgery of the Alimentary Tract

Disclosure: Nothing to disclose.

Additional Contributors

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, Society of American Gastrointestinal and Endoscopic Surgeons

Disclosure: Nothing to disclose.

Acknowledgements

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.

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.

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.