Snapshot A 17-year-old male presents with lower back pain. He reports that the pain worsens when he sits or bends forward. Medical history is significant for metabolic syndrome. He is a high school student who spends hours playing online computer games. On physical exam, there is a tender and fluctuant mass that is erythematous. There is also purulent discharge from a sinus tract. Introduction Clinical definition skin and subcutaneous tissue infection occurring in the sacrococcygeal region leading to an acute or chronic abscess Epidemiology incidence approximately 70,000 cases per year demographics 15-30 years of age location gluteal cleft risk factors increased hair poor hygiene prolonged sitting skin pits trauma or irritation of the region obesity family history Pathophysiology pathoanatomy unclear possibly due to stretching the natal cleft which damages the hair follicles and creates a pore "pit" pore serves as an environment for hair to become embedded hair is drawn deeper into the pore, resulting in a foreign body reaction and creating a subcutaneous cavity Prognosis approximately 50% of patients with acute pilonidal cyst may develop a chronic pilonidal cyst approximately 20% of cases treated with initial surgery have recurrence of the disease Presentation Symptoms asymptomatic intergluteal region pain while the patient is sitting or partaking in activities that stretch the natal cleft (e.g., bending) swelling drainage that can be mucoid, bloody, or purulent fever malaise Physical exam pores found in the midline of the natal cleft painless sinus opening tender mass or sinus with fluid drainage mass may be fluctuant and erythematous Studies Diagnostic criteria clinical diagnosis Differential Perianal abscess Hidradenitis suppurativa Anorectal fistula Folliculitis Perianal furuncle and carbuncle Perianal complications from Crohn's disease Treatment Operative incision and drainage indication considered first-line for acute pilonidal cyst surgical excision of the sinus tract indication chronic or persistent pilonidal cyst Complications Cellulitis Abscess Squamous cell carcinoma this is rare
QUESTIONS 1 of 1 1 Previous Next (M2.DM.17.4799) A 32-year-old man presents to his primary care physician complaining of a “boil” on his back. He first noticed a painful lump in the area one week ago, and he feels that it has increased in size since then. He states that it has become so painful that he has difficulty sitting still or lying flat on his back at night. He has not noticed any discharge from the lump. The patient has a past medical history of obesity and type II diabetes mellitus. He is currently taking metformin. He has a family history of beta-thalassemia in his mother and hypertension in his father. The patient is a computer programmer and in the evenings he plays ultimate frisbee. He smokes half a pack a day. At this office visit, his temperature is 98.2°F (36.8°C), pulse is 75/min, blood pressure is 138/82 mmHg, and respirations are 13/min. Physical exam is notable for the skin finding shown in Figure A. Which of the following is the best next step in management? QID: 109185 FIGURES: A Type & Select Correct Answer 1 Surgical excision 6% (3/53) 2 Cefazolin and metronidazole 0% (0/53) 3 Use of hot compresses 11% (6/53) 4 Incision and drainage 79% (42/53) 5 Ensure dryness and cleanliness in the affected area 4% (2/53) M 7 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept