Pilonidal Cyst: Symptoms, Causes, Diagnosis, Treatment, Surgery

Pilonidal cyst

The notion of a pilonidal cyst is incorrect.  It’s not a pilonidal cyst, it’s a pilonidal infection.  If there’s a tract that drains intermittently or always it’s correctly termed a pilonidal sinus.  Put more simply and inclusively, all pilonidal problems can be lumped together as pilonidal disease.

The symptoms may include pain, drainage, smell, swelling, and in its most severe form fever, redness of the affected area, and inability to sit.

Pilonidal problems are caused by factors associated with a deep valley or cleft between one’s buttock cheeks in an area termed the natal cleft.  Sitting or trauma ruptures hair follicles in the middle of this cleft and they become plugged with a protein called keratin and eventually rupture in the under-skin space (called the subcutaneous space).  Hair often becomes entrapped in the abscess over time and a draining sinus tract can eventually form (often above and to one side of the cleft).

The diagnosis is usually quite straightforward, but the doctor must understand the fundamentals of pilonidal disease in order to recognize it.  Many don’t, and misdiagnoses are common.

Treatment consists of simple drainage for acute or first-time pilonidal abscesses.  Once the condition has been present for many months or years and is not improving, surgery is usually required. 

When choosing and operation and a surgeon, please do your research.  The Cleft Lift Procedure is the only operation that I feel is appropriate for patients requiring pilonidal surgery.  Please do your research well and read the web pages on this site.  Choosing the correct operation and the right surgeon can be life changing in a positive way.

Jeffrey A. Sternberg, MD, FACS, FASCRS Pilonidal Surgery, Board-Certified Colorectal and General Surgeon located in Civic Center, Hayes Valley, San Francisco, CA

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