[Treatment of sacrococcygeal dermoid cysts; pilonidal cysts].
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Dermoid Cyst↗
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Pilonidal cyst on the vault. Case report.
Pilonidal cysts and sinuses are described as dermoid cysts which contain follicles of hairs and sebaceous glands. They clinically present as a classic case of inflammation which comes with pain, local infection and redness. The origin of pilonidal disease remains controverse. There are many hypothesis as lack of hygiene on the affected area and a penetration and growth of a hair in the subcutaneous tissue caused by constant friction or direct trauma on the damaged area. The option for clinical treatment is very frequent. However, taking into consideration the incidence and the possibility of recidive, surgical treatment is presently recommended. Complications include cellulitis and abscess formation. Pilonidal cysts are mostly found on the sacral region. In the literature is found description of pilonidal cysts on the penis, interdigital region on the hands as well as on the cervical region. We present a case of pilonidal cyst located on the vault biparietal region, without malignant degeneration.
Adult↗
[The use of drainage in the "per primam" treatment of recurrent pilonidal cysts].
Recurrent pilonidal sinus treatment is still controversial, as more and more frequently methods used determine unpleasant discomforts to the patients ("open" method) or increase recurrences rate. According to this consideration, the Authors have made a review of their cases (27 patients with recurrences), selected by standardized criteria and treated by "en bloc" excision of all pathologic tissue and following closure "per primam" of the wound, previously placing an aspirative drainage, then removed after 2 or 3 days. Ordinary use of the drainage, antibiotic prophylaxis extended to postoperative sixth or seventh day and daily careful disinfection of the wound and surrounding skin until suture removal got them excellent results.
Adolescent↗
[The radical treatment of sacrococcygeal pilonidal cysts].
Sacrococcygeal pilonidal disease may take a variety of forms: a silent chronic form, acute with abscess and a chronic or acute form with fistula. In the acute form surgery consists of the incision and evacuation of the purulent matter, postponing definitive surgery to a second phase, which is not always necessary, considering that in 60% of cases patients do not manifest any further symptoms. The final operation may be performed using a closed, semi-closed and open technique. The authors performed a retrospective review of 64 patients, including 44 males and 20 females. 75% of operations were performed using an open method, 22% with a closed method and 3% with a semi-closed method. Recidivations using the open method amounted to 8% (6% with a single recidivation, 2% with two recidivations), and 14% with the closed method. Average hospital stay was 5.8 days with the open method and 7.3 with the closed method. Patients operated using the open method were discharged after two or three days and dressings were applied using gauze soaked in Betadine solution after cleaning with hydrogen peroxide. The scar was fully formed in around 45 days.
Adult↗
Pilonidal cyst: cause and treatment.
PURPOSE: The treatment of sacrococcygeal pilonidal cyst, despite being considered a well-defined clinical entity and opinion as to its acquired origin being almost unanimous, has some controversial aspects. Surgery is the principal method of treatment, and several techniques have been proposed. All of them try to reduce morbidity, to offer conditions of fast cicatrization, to have a low recurrence rate, and to offer cure. This study was undertaken to review the available data in the literature about the cause of the disease and to determine the current optimal method of treatment, evaluating morbidity, healing, recurrence, and cure. METHODS: Data available on the topic of pilonidal cyst in the English-language literature were obtained from Index Medicus and MEDLINE and were reviewed and analyzed. RESULTS: There is nearly a consensus that pilonidal cyst is acquired, hair being the agent that causes the disease. Presently, the most-used surgical procedure is excision of the cyst, with open or closed wound for healing. However, many authors prefer to use the method of incision and curettage. New surgical techniques are being proposed. CONCLUSION: The majority of authors conclude that sacrococcygeal pilonidal cyst is an acquired disease, although a minority believe it is congenital. Although excision is the method of choice for most surgeons, in our experience the incision and curettage procedure is the best surgical treatment with regard to morbidity, healing, recurrence, and cure of the disease.
Cicatrix↗
Cutaneous ciliated cyst with interspersed apocrine features presenting as a pilonidal cyst in a child.
We present a case of a cutaneous ciliated cyst that presented in a 13-year-old female. The lesion was felt to be a pilonidal cyst, based on its location and clinical appearance. This case is unusual because it is the youngest reported example of this very rare lesion. In addition, the admixture of apocrine and ciliated cells is extremely unusual. The histogenesis of cutaneous ciliated cysts is considered.
Adolescent↗
[I. Dermoid cyst of the ovary with radiologically visible teeth. II. Two cases of radiological examination of dermoid cysts of the sacral region (pilonidal cyst)].
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Dermoid Cyst↗
Lumbar osteomyelitis and epidural abscess complicating recurrent pilonidal cyst: report of a case.
PURPOSE: This study was conducted to report the rare presentation of lumbar osteomyelitis and epidural abscess as a complication of a pilonidal cyst. METHODS: A case report is presented. RESULTS: We describe the rare case of a male patient with diabetes with a recurring pilonidal cyst who developed a lumbar osteomyelitis and epidural abscess three weeks after pilonidal cyst excision with epidural anesthesia, with a fatal outcome despite emergency treatment. CONCLUSIONS: Life-threatening complications should be kept in mind in high-risk patients with repetitive surgery and neurologic involvement.
Epidural Abscess↗
[Pilonidal cysts: the state of the art and the authors' personal experiences].
After a historical review of the pathogenesis and several therapies suggested for the treatment of pilonidal cysts the authors report the results of a retrospective study performed in the Department of Surgery during a period of four years, with at least 12 months follow-up. This study involved 53 patients (35 males and 15 females, 23 years average age) affected by pilonidal cyst. These patients were treated for a month with antibiotic therapy and underwent surgery by general anaesthesia. Before surgery blue methylene was injected in the cyst. Between 4 months and 2 years 5.7% of operated patients relapsed. After 10 days antibiotic therapy they underwent surgery again by local anaesthesia and then they followed an open treatment protocol including collagen and silver sulfadiazine, healing by delayed wound closure. Furthermore a depilating cream for the border of the wound was suggested to the patient. These patients healed in a period between 4 weeks and 2 months. No relapses were observed after at least 12 months. In our opinion there is the rationale to suggest an open treatment of relapsed pilonidal cyst based on the use of heterologous lyophilized collagen and silver sulfadiazine: it is well accepted by the patient and effective in relapses.
Adolescent↗
One-stage cure of infected pilonidal cysts.
Twenty-five patients with infected pilonidal cysts were treated by wide incision and drainage with curettage of the cyst lining. Twice-daily peroxide irrigations and permanent hair removal were advocated. General anesthesia was used in all but three patients. These also represented the only recurrences. Two of these had an inadequate initial surgical incision.
Adult↗
Pilonidal cyst and sinus; a simple, ambulatory surgical treatment.
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Cysts↗
Aerobic and anaerobic bacteriology of pilonidal cyst abscess in children.
Aspirates of pus from pilonidal abscesses in 25 children were studied for aerobic and anaerobic bacteria. A total of 76 isolates (63 anaerobic and 13 aerobic) were recovered from the patients, accounting for 2.52 anaerobes and 0.52 aerobes per specimen. Anaerobic organisms were recovered from all the specimens, and in eight cases (32%) they were mixed with aerobic organisms. The predominant anaerobic organisms were Bacteroides sp (36 isolates, including ten B fragilis group and ten B melaninogenicus group), Gram-positive anaerobic cocci (16). Fusobacterium sp (five), and Clostridium sp (four). The predominant aerobic organisms were Escherichia coli (four) and group D streptococci, alpha-hemolytic streptococci, and Proteus sp (two of each). We believe this study is the first to demonstrate the mixed anaerobic and aerobic bacteriology of pilonidal cyst abscesses in children.
Abscess↗
Anaerobic meningitis in an infant associated with pilonidal cyst abscess.
A 5-month-old infant whose infected pilonidal sinus was surgically removed, developed meningitis due to Bacteroides fragilis. A similar organism was also recovered from the infected pilonidal cyst along with anaerobic Gram positive cocci. The patient was treated with intravenous chloramphenicol for 4 weeks and recovered without sequela. Attention should be paid to the possibility of meningitis due to anaerobes in children with an infected pilonidal sinus.
Abscess↗
Outpatient excision and primary closure of pilonidal cysts and sinuses.
A procedure for outpatient excision and closure of pilonidal cysts and sinuses under local anesthesia is described. The operation is designed to reduce hospital expenses and loss of work time. It utilizes the low tissue friction properties of polypropylene sutures to effect full dead space obliteration and a home care regimen to minimize the incisional tension produced by sitting. Of thirty-two procedures performed, follow-up data were available for twenty-eight, with a mean postoperative time of twenty-four months. Full primary healing was obtained in all cases with a single early wound disruption. There have been no late recurrences.
Adult↗
[Pilonidal cysts and fistulas: radical excision "en bloc" and closure "per primam"].
For the radical surgical treatment of pilonidal cysts and fistulas, the authors suggest the excision "en bloc" of the complete pathological tissue and the primary closure, according to a procedure which considers not only a accurate surgical technique and a kind of dressing which avoids pressure and traction on the sutures, but also a s.t. antibiotic prophylaxis based on culture tests. This kind of approach in surgical treatment showed according to their experience, excellent immediate and long term results, causing slight inconvenience to patients, with a short recovery with regard to cases treated without primary closure.
Adolescent↗