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Pilonidal Cyst

Pilonidal abscesses are acquired, chronic infections of gluteal cleft hair folli-

cles over the sacral/perianal region. Pilonidal cysts are not related to the

anorectum in any way; however, because of their proximity, they are often

usually not for perirectal abscesses and vice-versa.

SYMPTOMS/EXAM

■ Tender, swollen, purulent nodule along superior gluteal fold

■ Abscessed pilonidal sinus is always located in posterior midline over

sacrum/coccyx. On the other hand, fistulas from perirectal abscesses are

usually not midline.

TREATMENT

■ Incision, drainage, packing +/−surgical follow-up for wide excision

■ No antibiotics necessary unless accompanying cellulitis present

COMPLICATIONS

Carcinoma is a rare complication of recurrent pilonidal sinus disease, usually

in men.

Proctitis

Sexually transmitted diseases of the anus may be caused by anal sex or occa-

sionally by spread from the vagina or scrotum (see Figure 11.6). If a patient

has one of these STDs, assume that others are present as well. Table 11.10

lists STDs that commonly cause proctitis.

ABDOMINAL AND GASTROINTESTINAL

EMERGENCIES

Pelvirectal

Intersphincteric

Perianal

Higher

intermuscular

Submucosal

Ischiorectal

FIGURE 11.5. Anatomical classification of common anorectal abscesses.

(Reproduced, with permission, from Tintinalli JE, Kelen GD, Stapczynski JS. Emergency Medicine: A Comprehensive Study

Guide,6th ed. New York: McGraw-Hill, 2004:544.)

Pilonidal cysts are always

midline and usually a couple

of centimeters above the

anus.