The mother of pilonidal cysts - Forum

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Surgeon

The mother of pilonidal cysts - Ärzteforum

Post#1 »

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?


Hans

Re: The mother of pilonidal cysts - Ärzteforum

Post#2 »

are you sure that`s a pilonidal cyst? Sounds like pyodermia fistulans
sinifica to me.
There were some German papers published about this entity, but I was
only able to find one English article:

Pyoderma fistulans sinifica (fox den disease): a distinctive soft-tissue
infection.

Jorjo

Re: The mother of pilonidal cysts - Ärzteforum

Post#3 »

the only way you will cure it is by
excising the whole lot down to deep fascia, the only question is whether you
patient is brave enough to go for the cure, or is he prepared to live with
it. We have seen some patients that sound like this where I think the cure
would be worse than the disease - but it doesn't sound so in your case.

User avatar
Resident

Re: The mother of pilonidal cysts - Ärzteforum

Post#4 »

We have treated another such patient very recently.

Could you photograph the patient's bum , scan it and send it to the
forum. Fox den disease has a TYPICAL apperance. BTW: is your patient an
African- American; is the process limited to his bum?

User avatar
Surgeon

Re: The mother of pilonidal cysts - Ärzteforum

Post#5 »

Thanks for the suggestions. I will take my camera in and try to get a picture
of this rear end to post on the list. You will have to pardon my technological
backwardness but it may take some time. If this butt has waited 30 years it
will wait a few weeks.

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