DOI: 10.1093/bjs/znad258.276 ISSN:

718 Pilonidal Disease: Diagnosis Which Can Be Unexpected

M Kazimirchyk
  • Surgery

Abstract

Background

Pilonidal disease is seen at sacrococcigeal region in prevalent number of cases. We present an unusual case of an abscess at lumbar region which turned out to be a pilonidal sinus.

Case presentation

A 18-year-old male presented to the outpatient clinic with swelling at lumbar area for 1 month. Physical examination revealed an inflammatory infiltrate 1,5*1,5cm, with fluctuation, located in the projection of L4-L5 vertebrae. The initial diagnosis of abscess was made.

Initial management

During incision and drainage of abscess 10 ml of malodorous purulent discharge emerged along with collection of hair. The subcutaneous tract was revealed which run caudally for 8 cm close upon gluteal cleft, where midline pit was discovered.

Diagnosis

Based on clinical presentation and intraoperative findings final diagnosis of pilonidal disease of sacrolumbar region was made.

Investigation

X-ray revealed asymmetric, deformed L5 vertebrae, with a possibility of being a developmental variation. The concurrent diagnosis of osteomyelitis was put into a question, which was rejected based on results of CT that revealed no bone-destructive pathology.

Final management

After healing of surgical wound subcutaneous sinusectomy at gluteal cleft was accomplished in the inpatient setting, no additional surgical interventions regarding the subcutaneous tract at lumbar region were performed.

Outcome

The patient was monitored intermittently after that for 9 months and no signs of recurrence were observed.

Conclusion

Draining sinus tract of a pilonidal cyst is able to spread to an apparently distant location that can markedly complicate the diagnosis.

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