Question: Surgical

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Kelly August 27, 2019 - 11:19 am Reply

D) Presents as indurated, sometimes fluctuant lesion just superior to intergluteal “natal” cleft; incision is best made off-midline

Pilonidal cysts and, when they become infected, abscesses, typically present in adolescents and adults, in 2:1 male:female ratio, as a painful swelling at the top of the intergluteal (“natal”) cleft. Obesity is a risk factor for both formation and recurrence. Pathophysiology is unclear but may involve clogged pores and hair follicle entrapment in a deep natal cleft. Incision and drainage of the pus provides relief of pain, and is best performed with an off midline incision over the area of maximum fluctuance. Packing may be placed, or vessel loop drainage used. Antibiotics are only needed if there is significant overlying or surrounding cellulitis. Recurrences are common (20-55%) and warrant referral to a surgeon for definitive removal of the cyst cavity.