Sometimes a person can live half his life without even suspecting that latent threats, such as a teratoma, an abnormality in the development of a kidney or coccyx cyst, may lurk in his body. The latter does not manifest itself in any way until a certain time, and the doctors just can not say what is associated with the appearance of clinical symptoms. At some point, this formation begins to become inflamed, pus forms, melting the soft tissues, and the problem becomes obvious.
Definition
Pilonidal cyst is an abnormality of the skin in the sacrococcygeal region. Synonyms for this diagnosis are the pilonidal sinus or epithelial coccygeal passage. The presence of skin retracts in the intergluteal fold may suggest an idea about this disease. After trauma to the coccyx or hypothermia of this area, the fistulous passage becomes inflamed and suppurates. After some time, he somehow opens up, forming additional fistulous passages and holes. If you do not resort to medical care, the disease is recurrent in nature.
Pilonidal cyst (ICD 10)
The international classification of diseases of the tenth revision has a section under the letter L, which, among other things, contains diseases of the skin and subcutaneous tissue. The pilonidal cyst is encoded under the code L05, it includes the coccygeal fistula and the pilonidal sinus. There are two subgroups:
- L05.0 - a cyst with an abscess;
- L05.9 - a cyst without an abscess.
This section also includes bullae, dermatitis, eczema, urticaria, diseases of the skin appendages and others.
Causes of cyst formation
As is known, the embryo undergoes the evolutionary stage during growth. He has a large head, a three-chambered heart, membranes and even a tail. Most doctors and pathomorphologists believe that the pilonidal coccyx cyst is a congenital defect in the external germ layer. This is due to incompletely reduced muscles and ligaments of this tail itself, which appears in the first weeks of gestation and should disappear after the eighth week.
There is another opinion on this issue. Some experts believe that the disease occurs due to ingrown hair into the subcutaneous fat. Adherents of this theory indicate the presence of epithelial passages between the fingers in hairdressers, in the cult of the amputated limb, in the axillary region.
More than a hundred years ago, neurologists proposed a theory according to which the epithelial coccygeal course is formed in the process of involution of the terminal segments of the spinal cord. Another explanation of how the pilonidal cyst is formed is in tune with the previous one: the coccygeal vertebrae, which in animals form the tail, dissolve, and in their place remains a rudimentary ligament. If this process is not completed completely, then a blind passage forms in this place, which can become inflamed.
Symptoms
The main age of patients with a diagnosis of “pilonidal cyst” is from sixteen to twenty-five years. Most often, representatives of southern nationalities are affected. The disease practically does not occur in the black race. Most often it affects men who drive a lot or take long walks, such as soldiers or truckers.
The epithelial passage is located along the midline in the intergluteal fold, it blindly ends in fatty tissue, and opens on the skin in the form of a wound. The section is a narrow tube up to three to four centimeters long. Inside it is lined with an epithelium that secretes mucus. Any mechanical injury or infection can delay the outflow of epithelial secretion and inflammation. A pilonidal cyst is nothing more than an inflamed fistula, which, with a high degree of probability, can turn into an abscess. In advanced cases, it reaches a significant value and can spontaneously open, melting the skin. This is a very painful process that can significantly complicate life.
There are uncomplicated and complicated epithelial coccygeal passage. In the first case, as a rule, there are no complaints. Sometimes there are dull pains in the coccyx, but they do not cause concern to the patient and occur only with prolonged sitting or slight injuries. Rarely, a pilonidal cyst is accompanied by itching and discharge in the intergluteal fold.
If the course of the disease is complicated, then there is an acute or chronic inflammation of the epithelial course, fever, severe pain in the abscess area, cicatricial changes appear at the site of healing fistulas. This usually alarms patients and forces them to consult a surgeon.
Diagnostics
It is important for the doctor to correctly and thoroughly collect an anamnesis. Most often, patients turn after an injury or when pain is pronounced. The presence of holes in the intergluteal region, inflammation at the site of the scar, a constant recurrent course of abscesses makes the diagnosis quite easy.
In order to find out how many holes there are and how far the fistulous passage deepens, the doctor injects a dye into it, most often methylene blue, and then watches where the liquid flows from. This method allows you to visualize all pus stains and completely remove them during surgery.
Uncomplicated Cyst Treatment
Pilonidal cyst without abscesses needs a planned surgical treatment, the time and method of which is selected individually for each patient. The general rule is only one: the intervention should take place during the period of remission of the disease. Radical surgery is necessary if purulent discharge appears from an external opening. The surgeon performs an excision of the skin flap along with subcutaneous tissue, up to the sacrococcygeal fascia. In order to facilitate access, the epithelial passages are stained with iodine, fucorcin or methylene blue. The wound is sutured in layers tightly or (with a deep or extensive lesion), hemming the edges of the wound to its bottom is carried out. The sutures are removed after two weeks, no significant cosmetic defects at the incision site are observed. With careful care, the disease is completely cured.
Complicated cyst treatment
Pilonidal cyst with an abscess requires a slightly different approach to treatment. If the inflammation does not extend beyond the intergluteal fold, has a diameter of no more than three centimeters and is located strictly along the canal path, then a radical intervention can be performed at once and the focus of inflammation completely removed. In the case of the spread of infiltrate before the operation, anti-inflammatory therapy is necessary.
When abscessing (that is, spontaneous breakthrough of the contents of the abscess), it is also preferable to first carry out anti-inflammatory therapy so that the intergluteal region becomes accessible for surgery, as well as to reduce the risk of postoperative complications. The delayed radical phase has several advantages:
- economical cut on the skin;
- maximum convergence of the edges of the wound.
Even if the infiltrate spreads to the sides, the main object remains the pilonidal cyst of the tailbone. The operation is done along the midline of the abscess. After access, the surgeon revises the wound to remove all necrotic masses and tear the tissue lintels, if any. Relapse prevention consists of a thorough examination of the operative field, removal of all necrotic detritus, excision of passages and sagging. Repeated inflammations are possible if the surgical intervention was not radical enough, the remains of the epithelial passage were preserved, hair or wound healing did not occur completely.
Military service
During the passage of the draft committee, the surgeon discovers a point pull near the anal opening with a hair sticking out of it. This causes certain concerns for the specialist, so the young man is asked leading questions: does his itch bother him, are there purulent discharge, were there any inflammations. If the answers are no, then the doctor gives recommendations on hygiene and notes that the soldier is fit for service.
But if at least one of the questions is answered positive, then surgical treatment is required, because conservative therapy does not exist. Intervention is carried out in a planned manner, if there is no indication for emergency action.
Recommendations for patients
The pilonidal cyst requires delicate postoperative care, so it is advisable for patients to follow the recommendations below:
- three weeks after surgery, sitting and lifting weights is not allowed;
- It is necessary to take a warm hygienic shower every day with washing the intergluteal area;
- within six months after the operation, every two weeks you need to remove hairs in the incision area;
- wear soft, non-squeezing underwear, without protruding seams.
The right approach will avoid relapses and facilitate future audits.
Complications
As a rule, a pilonidal cyst, the treatment of which is carried out only promptly, has a favorable prognosis, often a complete cure occurs. Unfortunately, sometimes complications are possible, such as:
- repeated abscesses (if the audit was not carried out completely);
- relapse of the disease (if the patient does not comply with the recommendations for the maintenance of the postoperative regimen);
- sepsis and septicopyemia (when a secondary bacterial infection joins);
- degeneration of epithelial tissues into squamous cell carcinoma.
The latter complication is extremely rare, but surgeons like to play safe in this case and the removed tissue is sent for histological examination in order to exclude oncological pathology.