Sinus pilonidalis

What is it?

This is a sac arising from the superficial fascia of the sacrum, which often contains hair and skin remnants. They most commonly form between the buttocks at the top near the coccyx on the line separating them. More than one may form, and they are usually connected by small subcutaneous tunnels called fistulas. In case of infection, they fill with pus. They are more common in men and are also associated with obesity, young age and people who spend a lot of time sitting. It is a benign disorder that can manifest as reddening of the skin, pain at the base of the spine, pus or blood from the affected area, and fever in case of a severe infection. A pilonidal cyst varies in size and may look like a small recess or may cover a large area.

Which are the symptoms?

These diseases are characterized by the appearance of an often-painful swelling of the sacro-copal region. This swelling can show signs of an abscess. Sometimes there is fistulization of the infected pilonidal sinus.

  • sacro-copal pain and protrusion
  • corpuscular drainage

How is it diagnosed?

The diagnosis can be made by an objective examination. Sometimes an ultrasound scan or, in special cases, an MRI may be indicated.

Suggested exams

How is it treated?

Treatment of infected pilonidal cysts usually involves surgical drainage to open the abscess and drain the pus and is usually performed on an outpatient basis or in emergencies where conservative treatment with antibiotics and anti-inflammatory drugs has been insufficient to manage the acute condition.

Elective surgical treatment includes various techniques, which are used depending on the clinical picture and are performed in day surgery, usually with local anaesthesia and sedation or with super-selective locoregional suturing:

Surgical excision with direct sutures or using different types of plastic surgery (closed technique) and the application of an advanced negative pressure dressing (PICO), which reduces to almost 0 the chance of reopening the wound due to profuse discharge after excision and traction to the wound occurring at that particular site.

When indicated, pilonidal fistula can be treated with laser coarctation, a painless technique that provides rapid healing in the absence of wounds with almost immediate resumption of all activities, including work and sport.

There is also a mixed technique, which consists of fistulectomy and/or removal of the cyst by selective carotization combined with laser coarctation of the small cavity and any other fistulous passages.

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