We have discussed pilonidal cysts management recently but I saw one
today that is larger than I've ever seen. This has been neglected for
thirty years and was sent to me for I&D of an abscess. He has had
multiple I&D's in the past. Healthy otherwise but very noncompliant.
His rear end shows indurated tracts extending 15 cms from the midline on
both sides. When I press on the center line, drops of pus exude from
several lateral tract openings at sites of previous drainages. After
the current infection is semicontrolled (had 10cc pus pocket by one of
the tracts), I advised him to consider surgical intervention. If I
excise all sick tissue and tract he would have a HUGE open area looking
like a deep starfish in his buttocks.
Any suggestions would be appreciated. Should I send him to you?