Pilonidal Sinus

Pain, swelling, and purulent, blood-stained drainage around the lower back had plagued a 21-year-old woman for 3 weeks. On examination, multiple openings were seen overlying the natal cleft, the sacrococcygeal region, and the upper part of the midline. The last was the area of drainage. Insertion of a metal probe at that point revealed a pilonidal sinus that communicated with centrally located openings. Dr Virendra A. Parikh of Fort Wayne, Ind, tells us that the patient required pilonidal cystectomy.

Pilonidal sinus, a common infective process in the sacrococcygeal region, occurs almost exclusively in teenagers and young adults. The term “pilonidal” (nest of hair) is used because the epithelial lining of the sinus usually contains hairs. The sinus is generally asymptomatic unless it becomes infected (most often after puberty); it then drains from one or more openings overlying the coccyx and sacrum. The infected abscess may extend to the perianal area in a presentation that can be mistaken for an anal fistula.

Incision and drainage relieve the symptoms of an acute pilonidal abscess. Definitive elective treatment of pilonidal disease includes excision and either primary closure or leaving the wound open to allow healing by secondary intention.