home Audience 5 Pilonidal fistula ICD 10. Defect: coccygeal tract. What is the epithelial coccygeal duct

Pilonidal fistula ICD 10. Defect: coccygeal tract. What is the epithelial coccygeal duct

Quite often there is a congenital pathology of the development of soft tissues in the sacral area - the epithelial coccygeal tract. In most cases, this disease is asymptomatic, and only in the presence of inflammation do patients consult a doctor. This pathology is most often seen in young men, most likely due to increased hair growth in this area. According to ICD 10, the disease is called a pilonidal cyst or pilonidal sinus. You can also find such designations for this condition as coccygeal fistula, coccyx cyst, epithelial coccygeal cyst.

What is the epithelial coccygeal duct

This congenital pathology is characterized by the presence of a narrow canal in the subcutaneous tissue in the area of the intergluteal fold. Usually this passage looks like a narrow tube 2-3 centimeters long, and it is directed towards the coccyx. But the channel is not connected to bone tissue, but ends blindly in the subcutaneous tissue. Inside it there is an epithelium with hair follicles, sebaceous and sweat glands. The other end of the epithelial coccygeal duct opens with one or more openings slightly above the anus, usually between or just above the buttocks.

Through these holes, remnants of the epithelium lining its surface from the inside can periodically be released. But they are also an entry point for infection, the penetration of which may cause inflammation of the epithelial coccygeal tract. This also happens when the primary openings of the canal are blocked. If its contents stagnate, microorganisms begin to multiply and purulent inflammation develops. It usually involves surrounding tissues. It is in these cases that patients consult a doctor.

Based on these characteristics, three types of piloidal cysts are distinguished: uncomplicated, which may not manifest itself at all throughout a person’s life, acute and chronic inflammation. The suppuration of the canal goes through the stages of infiltration and abscess. If the abscess opens on its own, a secondary opening of the coccygeal duct is formed. This usually results in chronic inflammation. Then the suppuration recurs, causing the formation of fistulas.

Causes

Now there are two theories regarding the cause of this defect. Most scientists believe that this is a congenital pathology. Such a canal is formed during intrauterine development. For some reason, the rudimental tail present in all embryos up to 5 weeks remains in the form of a tube lined with epithelium inside. This defect occurs quite often in newborns.

But doctors abroad identify other causes of pathology. Due to the fact that inflammation can very rarely be found in a child, and most often such a defect develops with increased hair growth in the intergluteal area, it is called a pilar cyst. It is believed that it appears due to improper growth or ingrowth of hair into the skin.

But in fact, these are the causes of inflammation, and not the appearance of the coccygeal passage. Other factors can also cause suppuration:

injuries of the coccyx and soft tissues;
combing the canal exit area;
failure to comply with hygiene rules;
diaper rash, overheating of the area between the buttocks;
prolonged sitting;
weakening of the immune system.

In most cases, the pathology does not manifest itself in any way, only causing pain and pus when inflamed.

Symptoms of pathology

In a newborn child, the pathology does not manifest itself in any way. The only symptom may be a dimple or small holes in the intergluteal fold. Only when hair growth begins and the sebaceous and sweat glands begin to work, certain signs of the disease may appear. Most often this is a slight itching, discharge from the primary orifices, increased humidity in the intergluteal fold, and sometimes a tuft of hair grows from the canal.

A suppurating epithelial tract has more pronounced symptoms. But patients often mistake them for the consequences of an injury, so the correct treatment of the disease does not always begin on time.

The disease is easy to detect when examined by a doctor, but testing may be required to confirm the diagnosis.

The following symptoms indicate the presence of inflammation:

pain in the area of the coccyx and sacrum, especially worse when sitting;
the skin around the canal becomes dense, redness and swelling are noticeable;
there is a discharge of ichor, and then pus from the openings of the passage;
without treatment, a chronic, recurring abscess occurs;
fistulas appear;
due to long-term purulent inflammation, signs of general intoxication of the body may appear - headaches, fatigue, fever.

Diagnosis of pathology

The epithelial coccygeal tract is usually easily identified during external examination. The doctor asks the patient about the symptoms and when they appeared. Conducts a digital examination of the rectum.

The complicated course of the disease with the presence of a fistula and abscess must be differentiated from other similar pathologies: rectal fistula, coccyx cyst, posterior meningocele, osteomyelitis, teratoma and others. To do this, various instrumental examinations are carried out, for example, sigmoidoscopy, colonoscopy, ultrasound or fistulography. Such a diagnosis is necessary in order to prescribe the correct treatment in a timely manner.

Complication of pathology

If the resulting inflammation is not treated, the abscess may open on its own, but in this case there is a high probability of developing complications. The most common consequence of an unoperated cyst is the appearance of fistulas through which purulent contents come out. They can open not only in the lumbosacral region, but in the rectum, pelvic organs, in the perineal area and the anterior abdominal wall.

Chronic inflammation periodically recurs with the appearance of new abscesses. Therefore, it is impossible to get rid of the epithelial coccygeal tract without surgery: if it becomes inflamed once, then the lesion remains for many years, threatening the appearance of complications. Pyoderma may develop, and if inflammation affects the vertebrae, then purulent osteomyelitis. There were even cases of the development of squamous cell carcinoma, the cause of which was inflammation of the epithelial coccygeal cyst.

In case of inflammation and the appearance of fistulas, complete removal of the coccygeal tract is necessary.

Treatment of the disease

Special measures are necessary in the presence of suppuration of the coccygeal cyst. The only way to stop inflammation and prevent complications is through surgery. But the methods of therapy are chosen by the doctor depending on the degree of the inflammatory process and other individual characteristics of the disease. Sometimes only palliative surgery is performed. It involves opening a purulent lesion and draining its contents. But in most cases this leads to remission of the disease.

Therefore, most often the canal is completely removed along with the primary holes. Sometimes excision of surrounding tissues and purulent fistulas is also required. It is best to carry out the operation in a specialized proctology department, where they know all the features of the anatomical structure of this zone. Otherwise, if all affected tissue is not completely removed, relapses are possible. But if the operation is performed correctly, the prognosis for cure is favorable.

Postoperative treatment of pathology is to prevent complications and wound infection. To do this, you must remove all hair in this area and take special hygiene measures. Often after surgery, a course of antibiotic therapy, physiotherapy, and anti-inflammatory ointments, for example, Levomekol, are prescribed. All this contributes to faster wound healing. After discharge from the hospital, you need to avoid physical overload for some time, periodically shave the hair in the tailbone area and not wear tight clothing that compresses this area. Usually complete healing occurs within a month.

It is best if a planned operation is performed to remove the uncomplicated epithelial coccygeal tract before the appearance of purulent inflammation. Typically, such treatment takes place without complications, since there is no microbial flora and inflammation. If an abscess has already appeared, you must first open it, clean the cavity of pus, hair and other contents and install drainage. Only after the acute symptoms have subsided is the canal excision and suturing performed. This is usually done after 4-5 days. But sometimes the second stage of the operation is postponed for a couple of months. If the patient does not come for the planned removal of the canal, the inflammation enters the chronic stage.

If an abscess appears, it must first be opened and drainage installed to drain the contents

Conservative treatment of cysts

Complete cure and prevention of recurrent inflammation is possible only with the help of surgery. But sometimes conservative treatment is also carried out, which does not exclude the possibility of relapses. It can only relieve symptoms: pain, inflammation and swelling. For this purpose, anti-inflammatory drugs, antibiotics, as well as folk remedies are used:

apply a napkin soaked in calendula or propolis tincture to the area of inflammation;
make a decoction of St. John's wort, drain the water, spread the grass on polyethylene and sit on it;
lubricate the site of inflammation with toothpaste with pine extract;
mix a tablespoon of tar with 2 tablespoons of butter, make compresses from the resulting mixture at night;
do sitz baths with chamomile decoction or Furacilin solution.

Disease prevention

This pathology is congenital, so it is impossible to prevent its occurrence. But the development of inflammation and complications can be excluded. If an epithelial coccygeal cyst is discovered during examination by a doctor, it is advisable to remove it, even if no symptoms bother you. Due to its anatomical features, the area of the intergluteal fold is easily infected and often injured. Therefore, relapse of inflammation is very likely. To prevent complications, it is necessary to avoid increased stress, prolonged sitting, observe rules of hygiene, and do not overcool.

The epithelial coccygeal tract is a pathology that is quite common, especially in young people aged 15-30 years. In many cases, the patient may not suspect that he has such a defect. Only in the presence of provoking factors does the channel become inflamed and begin to interfere. In this case, only surgical removal of the tract can help, which should not be postponed.

The epithelial coccygeal tract is a pathology of the development of soft tissues, characterized by the presence of a cavity in the form of a narrow tube, which is located in the intergluteal fold of the sacrococcygeal region. In medical practice, synonyms for ECX are also used: pilonidal sinus, dermoid fistula of the coccyx, dermoid cyst of the coccyx, sequestral dermoid, epithelial immersion of the coccygeal zone, sacrococcygeal sinus, pilar cyst.

The tubular epithelial cavity begins above the anal passage, extends towards the coccyx and has a blind ending that is not in contact with either the coccyx or the sacrum. The waste products of the epithelium cover the passage and, accumulating, exit through pinholes (the so-called primary epithelial passages) located in the intergluteal fold. Exit openings can serve as a route for external infection.

Blockage of the primary orifices, mechanical injuries and infection of the tract lead to an inflammatory process that spreads to the fatty tissue. As a result, the epithelial coccygeal duct swells, its walls are deformed, and an abscess is formed in the coccyx area, expressed as a purulent formation. The abscess can be significant in size and, as a rule, breaks through the skin over time, creating a secondary epithelial tract.

Causes of epithelial coccygeal duct

In domestic medicine, ECX is considered a congenital pathology and is an atavism. It is based on an embryonic disorder in the formation of the soft tissues of the sacrococcygeal zone: in the tenth week of intrauterine development, a tail appears and then disappears in each fetus. But if its muscles are not completely reduced, then the coccygeal tract is formed.

In foreign medical practice, along with the concept of the congenital nature of the pathology, there is also a theory of the acquired etiology of the defect. For example, as a result of injuries, purulent lesions and skin moderation, the hair follicle can descend into the subdermal layer. The hair, having no way out, grows inside, which causes inflammation with the formation of purulent cavities. In any case, the controversy about the causes of the formation of the epithelial coccygeal duct is of only scientific interest, but does not affect the choice of treatment.

Classification of the epithelial coccygeal tract

The clinical picture suggests systematization of ECX into forms, each of which has its own stage of development of the inflammatory process.

The epithelial coccygeal tract is uncomplicated (without clinical manifestations);
Acute inflammation of the epithelial coccygeal duct:
- infiltrate - compaction in the subcutaneous tissue;
- abscess - accumulation of pus as a result of an inflammatory process;
Chronic form of the epithelial coccygeal tract:
- infiltrate caused by the accumulation of lymph, blood and rapidly multiplying cells;
- purulent fistula - a canal with an exit to the outside;
- relapse - repeated manifestation of the epithelial coccygeal tract;
The period of remission is a stage characterized by the weakening or disappearance of signs of the disease.

Symptoms of the epithelial coccygeal tract

Before the age of 15, pilonidal disease usually does not manifest itself. There are options when the presence of this pathology is not detected throughout life. The disease practically does not occur in people over 40 years of age. In men, pathology is detected three times more often than in women.

The first signs of ECC are usually detected during puberty. This is due to the beginning of intensive hair growth in the intergluteal region, the accumulation of sweat and sebaceous gland products in them, and the location of the tract near the anus ensures the spread of microorganisms, which leads to inflammation and the subsequent discovery of the epithelial coccygeal tract.

During the occurrence of the inflammatory process, the patient experiences unpleasant sensations, which are characterized by:

Pain in the sacrococcygeal region;
Formation of clearly defined compactions;
Bloody or purulent discharges from the primary orifices.

If the patient does not consult a proctologist in a timely manner, the inflammatory process of ECC worsens and leads to:

To swelling and redness of adjacent tissues;
The appearance of fistulas;
Infection of the coccygeal cavity;
Rising temperature.

After the treatment program, the patient enters a period of remission. However, there is always a risk of relapse with development into a chronic form of pilonidal disease.

Factors that provoke inflammation of the epithelial coccygeal duct are:

Mechanical injuries;
Failure to comply with personal hygiene rules;
Increased hair growth in the intergluteal area;
Introduction of hair into the subdermal layer of skin of the sacrococcygeal area;
Itching followed by scratching.

Diagnosis of the epithelial coccygeal tract

Diagnosing the epithelial coccygeal tract, in most cases, is not difficult. To identify it, the proctologist uses visual and digital examination methods. At the time of inflammation, the doctor determines the presence of a compaction, abscess, primary or secondary passages.

To exclude other pathologies, the following examination methods can be used:

Palpation of the anus;
Sigmoidoscopy - diagnosis of the rectum;
Colonoscopy - diagnosis of colon.

However, if the patient applied on time and the disease did not take a chronic form, then there is no need for extensive diagnostic measures. In rare cases, fistulography is prescribed to differentiate pilonidal disease from other diseases.

Differential diagnosis

ECC should be differentiated from osteomyelitis of the coccyx and sacrum bones, cystic formations, pyoderma with fistulas, posterior meningocele, rectal fistula. Therefore, probing of the tract, sigmoidoscopy and colonoscopy are mandatory measures to exclude the above pathologies.

The coccygeal cyst is painless and mobile when palpated. However, when suppurating, its clinical symptoms may coincide with the epithelial coccygeal tract. However, a careful examination of the coccygeal cyst does not reveal the primary passages inherent in ECC.

A presacral cyst (teratoma) may have a course that mimics the primary coccygeal foramen. In addition, the cyst can provoke purulent inflammation in the sacral and coccygeal area. Additional examination using ultrasound and fistulography provides differentiation of diagnoses.
Posterior meningocele (protrusion in the sacrococcygeal area) is a disease that must be distinguished from the coccygeal tract. The difference lies in the absence of primary holes; upon palpation, the seal is almost motionless and has a dense elastic consistency. The clinical picture of posterior meningocele is complemented by functional disorders of the pelvic organs: enuresis is often observed. To differentiate these diagnoses, radiography of the sacral region and consultation with a neurosurgeon are prescribed.
A rectal fistula must also be distinguished from a coccygeal fistula. The course of the first goes towards the rectum, which is revealed by probing. Fistulography reveals the second exit of the fistula into one of the rectal sinuses.

Possible complications if you refuse radical treatment

In some cases, patients postpone surgery indefinitely or refuse it altogether, limiting themselves to opening and draining purulent formations. However, this practice only leads to the involvement of nearby tissues in the inflammatory process, their infection, the formation of an abscess, multiple ulcers and fistulas with outlets into the inguinal folds, perineum, sacrum, and pelvic organs. When the pathology spreads towards the coccyx, the development of fistulous pyoderma or purulent lesions of the pelvic bones (osteomyelitis) is possible. In addition, against the background of a chronic form of the epithelial coccygeal tract, pyoderma and actinomycosis can be observed.

Having carried out all kinds of therapeutic programs and not achieving a cure, the patient is still forced to contact a proctologist in order to prescribe a radical operation. However, in this case, the surgical procedure takes place on a larger scale, and postoperative therapy requires a long time, the recovery period is more difficult, and in addition, there is a high probability of relapse.

Treatment of epithelial coccygeal duct

The only effective treatment for ECC is surgery. The operation is performed using two methods: radical or palliative. In the first case, the surgeon completely removes the walls of the tract with primary and secondary openings and inflamed tissue adjacent to the tract, then applies sutures. In the second, the abscess is opened and drained.

Radical removal is performed routinely in the absence of acute inflammatory processes (uncomplicated form of ECC).

The palliative method involves treating the epithelial coccygeal tract in two stages: curing the abscess, ulcers by opening or local excision, followed by relieving general inflammation, then prescribing a planned radical operation.

In the postoperative period, the following is prescribed:

A course of antibacterial therapy with broad-spectrum antibiotics. The duration of treatment is usually no more than 7 days;
Ointments that improve the regeneration of damaged tissue;
Physiotherapy to promote healing of the injured intergluteal area.

After the operation, a relapse is possible, which indicates poor quality of its implementation: incomplete excision of infected tissue, purulent formations, fistulas, primary tracts, etc. As a rule, patients who had the epithelial coccygeal tract removed in the inpatient department of general surgery come with repeated inflammation. Despite the fact that the operation is not particularly difficult, there are a number of specific aspects of pilonidal disease and structural features of the pararectal zone, which, due to daily practice, only specialists from the coloproctology department are able to take into account.

Prognosis for epithelial coccygeal tract

The scenario for complete cure of the pilonidal sinus is favorable only if timely radical excision of the EC and all tissues affected by inflammation is carried out.

In order to prevent complications and exacerbations in the postoperative period, it is recommended:

Systematically carry out epilation along the edges of the wound;
Observe hygiene rules of the perianal and intergluteal zones;
Avoid physical activity;
Use soft underwear and avoid tight clothing with a rough seam in the middle to avoid irritation and injury to the postoperative scar.

The coccygeal passage is a narrow epithelial cavity in the form of a capsule in the subcutaneous tissue of the fold between the buttocks, which is located at the level of the coccyx, but is not connected by the sacrum. This is a congenital pathology, which is also called a pilonidal cyst. The epithelial coccygeal duct (ECX) may not make itself felt for a very long time. But at the same time, there is always a threat of the development of an inflammatory process.

The defect is quite common among males. Exacerbation of pilonidal cyst is most often diagnosed at the age of 15-26 years. In the cavity of the cyst there are significant amounts of particles of desquamated epithelium and fatty tissue; this is a place where a large number of bacteria accumulate. Therefore, an inflammatory process may occur at any time, which requires mandatory medical intervention.

Causes of the appearance of the epithelial coccygeal duct

There are several versions that explain the occurrence of ECX. According to one of them, disorders arise during the period of human embryonic development. In the area of the coccyx, channels remain under the skin, which on the surface look like holes, reminiscent of enlarged pores. Inside, these openings are covered with glands that secrete sweat and fat, and hair follicles. The inflammatory process in a pilonidal cyst usually occurs during adolescence, when hair actively begins to grow and sebum is secreted.

Another theory explains the appearance of the coccygeal tract by the physiological characteristics and hormonal changes of each individual person. This may be excess hair, a very deep fold between the buttocks and other factors.

Risk factors:

poor hygienic care of the gluteal area;
injuries in the coccyx area;
sedentary lifestyle;
obstruction in the sweat gland duct;
weakened immune system.

Forms and stages of development

Based on the clinical picture, ECX is divided into:

uncomplicated (without signs of an inflammatory process);
complicated (accompanied by a purulent process).

Inflammation of the coccygeal passage can be acute and chronic. The development of the pathological process develops in several stages:

Initial- primary fistula tracts are formed in the intergluteal fold. Periodically, the contents of the cyst may leak out through them.
Infiltrative- a round, painful lump forms in the intergluteal fold.
Abscessation(pilonidal abscess) - ulcers form in the area of the coccygeal tract.

The chronic form of the disease is characterized by stages of remissions and exacerbations, in which the process of inflammation of the coccygeal tract is periodically repeated.

Clinical picture

For a long period of time, a pilonidal cyst may not manifest itself in any way. Only minor discharge of epithelial products that line the tract may be noted. In such situations, the discovery of primary fistulas can be completely accidental.

Over time, under the influence of predisposing factors that clog the primary openings, epithelial waste products lose the ability to come out. This becomes fertile ground for the development of the inflammatory process. Its progression leads to the appearance of an abscess. It can reach such a size that it forms a secondary hole (or several) in the skin and comes out.

At the initial stage of abscess formation, patients may notice slight soreness, which causes some discomfort when moving. Gradually, the pain becomes more pronounced, the temperature rises, the skin in the area where the abscess forms swells and becomes hyperemic.

If the disease takes a chronic form, then the secondary opening does not tighten, and the patient constantly experiences purulent discharge. In this case, swelling and redness of the skin are not observed, as during an exacerbation. Over time, tissue scarring occurs around secondary fistulas. In this case, some holes may heal, while others remain open, and pus will continue to leak through them.

On a note! Without prompt, qualified assistance, the pilonidal cyst becomes chronic or recurrent. Secondary fistulas become scarred, and the patient may forget about the disease for several months or years. Then the inflammatory process develops with renewed vigor.

Diagnostics

As a rule, a proctologist can make a primary diagnosis based on a visual examination and digital examination of the rectum for the presence of fistulas.

A more thorough history is required to confirm ECC and differentiate it from other pathologies. It is necessary to find out when the first symptoms appeared and the dynamics of their changes. The doctor asks if any of the relatives have similar problems. It is very important to find out what diseases the patient has suffered and whether there are any chronic pathologies in the anamnesis.

If necessary, instrumental diagnostic methods are prescribed:

sigmoidoscopy;
colonoscopy;
irrigoscopy;
fistulography using contrast (to differentiate the coccygeal tract from a rectal fistula).

The epithelial coccygeal tract must be differentiated from presacral teratoma (tumor).

After completing all the studies, the patient should contact the surgeon to draw up a further plan of action.

General rules and methods of treatment

Treatment tactics for the coccygeal tract will depend on the degree and stage of inflammation. In any case, the only way to get rid of the pathology is surgery. In case of uncomplicated EC, a palliative operation can be performed, during which the abscess is opened and drained. Subsequently, remission occurs.

To completely cure the pathology, radical intervention is necessary. In case of acute purulent inflammation, one-stage or two-stage surgical intervention is performed, taking into account the stage and extent of inflammation.

The skin-fat flap of the tracts is excised to the sacrococcygeal fascia. Before surgery, the primary tracts must be painted in order to visualize all the openings and branches of the tract. The coccygeal passage is removed along with the skin of the intergluteal fold and all the holes located there. The wound is sutured tightly or the edges of the skin are sutured to the bottom.

After 10-12 days, the stitches are removed. After surgery, it is very important to provide proper wound care. Hair should be constantly removed from the edges. It is recommended to apply local products based on components that promote tissue regeneration and accelerate wound healing.

If the abscess has spread over a large surface, then first they carry out drug therapy with anti-inflammatory drugs, then resort to radical measures.

It is better to operate on the coccygeal tract as planned, before complications arise. In this case, the risk of postoperative complications is lower, and recovery is faster. The later treatment is started, the longer and more difficult it will be, and the likelihood of relapse increases.

Relapse Prevention

After surgery, it is very important to adhere to certain rules to avoid recurrence of the coccygeal tract:

You cannot sit or lift heavy objects for 3 weeks after the intervention.
After the stitches are removed, you need to take a shower every day and wash the intergluteal fold.
Twice a month, shave the hair in the area of the operation.
Don't wear tight clothes.

Relapses, as a rule, occur due to insufficient surgical intervention, in which some areas of the coccygeal tract were not removed, as well as due to improper care of the wound after surgery.

On the page, read about the causes of back pain in the lower spine in women and the features of pain treatment.

Complications and prognosis

When an abscess forms, secondary openings can form in the anus, scrotum, anterior abdominal wall, and sacrum. When the tailbone is drawn into the inflammatory process, there is a high risk of developing osteomyelitis (purulent bone lesions) and fistulous pyoderma.

According to statistics, 30-40% of patients who are treated in general surgical hospitals have postoperative complications. Therefore, it is better to undergo treatment in proctology departments. The prognosis for the coccygeal tract after proper treatment is favorable. Main: follow all instructions during the postoperative period.

The coccygeal passage is a pathology that cannot be ignored. The progression of a pilonidal cyst can lead to the development of an abscess and cause various complications. The earlier the disease is identified, the easier it is to treat it and prevent relapses.

Video - review of what the epithelial coccygeal duct is and how rehabilitation proceeds after surgery:

Epithelial pilonidal disease (ECD) is a congenital anomaly that is a pathology of soft tissues. A subcutaneous canal with one or more exits to the surface is formed above the buttocks. In medicine, this phenomenon is also known as a cyst or fistula of the coccyx and pilonidal sinus. A coccyx cyst does not pose a threat to the patient’s life, but causes numerous inconveniences in the form of repeated suppuration and inflammation, the formation of pyoderma of the intergluteal fold, and others.

The disease affects men and women under 30 years of age, and in most cases it is asymptomatic.

What does the epithelial coccygeal duct look like?

The pilonidal cone is a narrow canal in the subcutaneous tissue, the walls of which are lined with epithelium consisting of many sebaceous glands, hair follicles and sweat glands, as well as connective fibers. It is not connected with the sacrococcygeal region, but is closed blindly in the subcutaneous tissue. Systematically, accumulated waste products of the epithelium are released from the stomata, which open at one or several points.

Photos of the epithelial coccygeal tract in a hidden form do not give an idea of the scale of the problem, since pathological changes are not noticeable on the skin of the sacrococcygeal region.

In some cases, when an infection penetrates inside the epithelial coccygeal duct or its external openings are blocked, inflammation begins inside the formation with the formation of an abscess. It is at such moments that ECX is often detected.

A rapidly increasing abscess, which can spontaneously open, is evidence of a coccygeal cyst, and after opening, a deep fistula is formed.

Causes of pathology

The main causes of coccyx cysts are still unknown. It has been established that this pathology appears at the stage of intrauterine development, when a space lined with epithelial tissue forms between the buttocks in the fold. The reasons for its appearance are unknown, and there are no statistics on the number of children born with ECC.

According to experts, the causes of epithelial coccygeal duct in the fetus in 99% of cases are associated with a hereditary factor. If one of the parents has been diagnosed with this disease, the risk of its detection in children increases several times.

Also, the formation of a coccygeal cyst can occur in an adult, but there are specific reasons for this:

Bruise of soft tissues in the coccyx area or other injury, as a result of which a purulent focus is formed in the form of a narrow tube under the skin. After the pus comes out and the external opening heals, the cavity remains and periodically becomes inflamed.
Inflammation and suppuration of the skin in the intergluteal fold (boils), resulting from clogged pores, inflammation of acne and insufficient hygiene.
Thick hair in the area of the coccyx and sacrum, especially if there are ingrown hairs. In such situations, inflammation of the soft tissues may occur with the formation of a fistula.

The same factors influence the condition of a congenital coccygeal cyst. As a result of a bruise, hair, epithelium, and bacteria entering the external opening, inflammation and exudate occur.

Inflammatory and purulent processes in the pilonidal cone often begin in people leading a sedentary lifestyle. Insufficient blood circulation and stagnant processes in the soft tissues of the sacrococcygeal region contribute to the manifestation of pathology.

The main problem of early detection of pilonidal cyst is its hidden course. Until inflammation begins with the release of exudate and the formation of an abscess, a person is unaware of its presence.

Classification of coccygeal cyst

The epithelial coccygeal tract does not have a complex classification. Proctologists distinguish two types of pathology:

uncomplicated, occurring without clinical manifestations;
complicated, with the formation of exudate, abscess and/or fistulas.

In a complicated course, the disease occurs in two stages. At the first stage, which is called infiltrative, sweat and fat secretions, ichor and exudate accumulate in the cyst cavity. The skin over the cyst turns red and swells. The photo below is an example of what such inflammation may look like.

At the second stage, which is called abscess formation, the formation of one or more abscesses occurs, which open out.

In rare cases, pus leaks into the soft tissue. In this case, new foci or tracts form, and the disease takes on a chronic form.

In a chronic course, the epithelial coccygeal tract occurs in three stages:

infiltrative;
recurrent abscess;
stage of purulent fistula.

After an exacerbation, remission occurs, the duration of which varies depending on many factors. The only way to permanently get rid of chronic inflammation of the epithelial coccygeal tract is surgical intervention.

How does ECC manifest - signs and symptoms

The main sign of exacerbation of a coccyx cyst is throbbing or aching pain in the sacrum or coccyx, accompanied by exudate from the opened holes. Inflammation occurs in the area:

redness;
tissue compaction;
one or more abscesses along the course of the cyst.

With proper therapy, the suppurating epithelial coccygeal duct opens up on its own. If this does not happen, the doctor (proctologist or surgeon) decides to incise the skin over the source of suppuration. After cleansing the EC cavity, a temporary improvement occurs and the symptoms subside. The photo below shows a surgically opened abscess that formed above the epithelial coccygeal duct.

After opening, the remission stage begins, and then, if an operation to excise the cyst was not performed, the process is repeated.

In the case of chronic inflammation of the ECC, the likelihood of developing pyoderma is high. This condition is characterized by the formation of an extensive network of subcutaneous passages, sweat and fat secretions, pus and hair. Only surgical intervention can help in this situation.

Diagnostic methods

The diagnosis of a pilonidal cyst in most cases occurs after the onset of the inflammatory process, since in its absence the disease is asymptomatic. When unpleasant symptoms of EC suppuration appear, ulcers and fistulas form, the diagnosis becomes undeniable.

If the fistulous form of the coccyx cyst has begun, a detailed examination is carried out in order to exclude other pathologies:

rectal fistula;
meningocele;
presacral teratoma;
osteomyelitis and others.

The diagnosis is carried out by a proctologist. To begin with, a digital examination of the rectum is carried out for changes in the Morganian crypts and the internal opening of the fistulous tract. The sacral and coccygeal vertebrae are also palpated. With the epithelial coccygeal course there are no changes in them.

To exclude rectal disease, an instrumental examination is performed:

sigmoidoscopy;
irrigoscopy or colonoscopy (in the presence of alarming symptoms);
fistulography;
radiography of the sacrococcygeal region;
Ultrasound of the pelvic organs.

The listed instrumental diagnostic methods are used only if there are doubts regarding the nature of inflammation in the area of the coccyx and sacrum.

Treatment of epithelial coccygeal duct

You should not delay treatment of the epithelial coccygeal duct, especially if its inflammation has begun. In this case, a conservative method or surgery is used. The first is significantly inferior in effectiveness to surgical intervention, but it is indispensable in preparation for it and during recovery after surgery.

Conservative treatment

Drug treatment is used at the stage of acute exacerbation and involves the use of several groups of drugs:

broad-spectrum antibiotics or drugs against the identified type of microorganisms;
anti-inflammatory drugs;
analgesics.

Antibiotics are often given orally. Anti-inflammatory and painkillers are prescribed both in tablet form and in external form. Ointments and gels, when applied directly to the site of inflammation, help to quickly eliminate symptoms and alleviate the course of the disease before the planned procedure of opening the abscess or excision of the epithelial tracts.

Drug treatment without surgery is ineffective and often leads to re-inflammation, especially if it was done independently without consulting a doctor.

Important! Heating an inflamed pilonidal cyst is strictly prohibited. This can cause pus to spread into surrounding tissues.

Surgery

The type of surgical intervention for this diagnosis is chosen based on the patient’s condition. In the absence of signs of inflammation, the epithelial coccygeal duct is excised after staining its cavities with a solution of methylene blue. With this manipulation, it is possible to identify all the primary openings of the pilonidal cyst. Next, a strip of skin with subcutaneous tissue in which the tract is located is excised.

Removal of uncomplicated ECC has many advantages:

the risk of postoperative tissue infection tends to zero, since there are no pathogenic microflora in them;
the wound area is smaller;
the stitch heals faster.

Recovery after surgery lasts about a month. The sutures are removed on days 10-12, and until this time the patient is advised to be careful when walking for the first week. The consequences of the operation are visible in the photo below.

In the first days after the intervention, bed rest should be observed so that the load on the sutures is minimal.

The operation to remove the suppurating epithelial coccygeal tract is performed somewhat differently. It is prescribed only after the inflammatory process has been stopped and the purulent cavity has been opened and cleaned. The process of eliminating pathology takes place in two stages:

The abscess is opened and drained. It is washed every day for 4-5 days and water-soluble ointments are introduced into the cavity.
A radical excision of the epithelial coccygeal duct is performed.

Recovery after surgery in this case lasts longer, but the risk of relapse becomes zero.

In the chronic course of the disease, surgery is performed in the stage of remission or infiltration as planned. In this case, a radical removal of the epithelial coccygeal tract, secondary fistulas and primary openings is immediately performed.

The most difficult procedure is considered to be one in which the fistulous form of ECC is removed with the spread of inflammation to the soft tissue around the passages. In this case, the wound surface is too large, which does not allow sutures due to excessive tissue tension.

After surgery, the patient should visit the doctor periodically. Until the postoperative wound is completely healed, it is recommended to remove hair near the seam and maintain hygiene of the coccyx and sacrum, wear clothes made of soft fabrics, preferably without seams at the back.

Complications after surgery performed in coloproctology departments occur much less frequently than those performed in general surgical hospitals.

The prognosis after surgery is favorable at any stage and form of pathology. Patients completely get rid of unpleasant symptoms and manifestations of the disease.

Possible complications

In the absence of therapy, the epithelial coccygeal tract is complicated by extensive inflammation and suppuration of the soft tissues in the area of the sacrum and coccyx. In this case, fistulas are formed that open in the perineum, in the inguinal folds, between the buttocks, and sometimes on the genitals.

Another common complication of ECX is pyoderma with the addition of a bacterial or coccal infection (pictured below).

This disease requires gradual excision of the affected areas. All this takes the patient out of his usual routine for a long time.

Prevention

The appearance of the epithelial coccygeal tract, or more precisely, its inflammation and suppuration, can be avoided by using simple preventive measures. Firstly, you should avoid injury and hypothermia of the sacrolumbar region. Secondly, you need to maintain hygiene: thoroughly wash the sacrum, coccyx and intergluteal fold daily, remove hair as it grows, especially if it is thick. Thirdly, there is no need to delay the operation, even if the pilonidal cone does not cause discomfort.

It is advisable to address the problem not to a surgeon, but to a proctologist. A doctor of this specialization is more competent in the treatment of the epithelial coccygeal duct, which allows you to get rid of the problem without the risk of complications. In conclusion, a video in which a coloproctologist at the Neo-Med clinic talks about the features of the epithelial coccygeal duct, diagnosis and treatment of the disease.

Epithelial coccygeal tract - a defect in the development of soft tissues in the area of the sacrum and coccyx obtained at birth.

The coccygeal passage is a fairly common disease that occurs in men 3 times more often than in women. Mostly, young people from 15 to 26 years old suffer from epithelial coccygeal duct. According to statistics, the coccygeal tract is least common in African Americans, more often in Arabs and Caucasian peoples, who are distinguished by increased hair growth.

According to one theory, the epithelial coccygeal duct is a skin defect that appears due to incomplete reduction of the former tail muscles.

According to another version, the coccygeal tract occurs due to improper hair growth, which grows into the subcutaneous tissue in the coccyx area.

The coccygeal passage has the shape of a narrow tube located under the gluteal fold. Inside the tube of the coccygeal passage there is an epithelium that has the properties of ordinary skin (there are hair follicles, as well as sebaceous and sweat glands).

The coccygeal passage has a primary opening, which has access to the surface of the skin. Sometimes a person can live his whole life and not notice the presence of a small dimple or hole. The coccygeal passage is also popularly called the “posterior navel.” In rare cases, an original tuft of hair grows in place of the tailbone. It is believed that human ancestors once grew a tail in this place. The embryo in the womb at 5 weeks still has a tail, which at 6 weeks decreases and disappears over time.

The coccygeal passage can open outward with one or more small holes. From time to time, waste products of the epithelium lining the coccygeal passage emerge through these openings. Infection can get into these same holes. Blockage of the ducts or infection in them, as well as injury, contribute to the retention of contents in the lumen of the coccygeal passage and lead to the development of inflammation.

Inflammation can provoke expansion of the epithelial coccygeal duct, destruction of its wall and involvement of surrounding tissue in the inflammatory process. The abscess begins to develop and reaches such a size that it opens out in the form of a purulent fistula. This is how a secondary hole appears. In almost half of the cases, hair was found inside the epithelial coccygeal duct or cyst that had grown into the side walls and formed additional ducts.

Inflammation of the coccygeal passage

In normal conditions, the coccygeal passage may not bother a person. But if bacteria enter the primary opening of the coccygeal passage, acute inflammation may begin.

Causes and risk factors for the development of inflammation of the coccygeal tract:

lack of hygiene;
abrasions and scratches;
intertrigo;
sedentary lifestyle, prolonged sitting;
weak immunity;
obstructive phenomena in the sweat gland duct;
coccyx injuries.

Symptoms of the epithelial coccygeal tract

Symptoms of the disease depend on many reasons - age, the presence or absence of inflammatory changes, etc. This is determined by the following indicators:

pathological discharge from the fistula tract (ichor, pus);
pain in the coccyx area (it becomes difficult for a person to sit);
infiltration of surrounding tissues;
increase in body temperature.

Diagnosis of the coccygeal tract

Diagnosis of the disease does not present any particular difficulties and includes examination of the sacrococcygeal region and probing of the fistula tract. However, the presence of a number of pathological conditions masquerading as this disease (cysts, rectal fistulas, osteomyelitis, tuberculosis) requires additional instrumental diagnostic methods, such as:

ultrasound examination of soft tissues of the sacrococcygeal region;
X-ray examination of the sacrum and coccyx;

Treatment of the coccygeal tract

Treatment of the coccygeal tract is only surgical and depends on the degree and severity of inflammatory changes in the area of the coccygeal tract. In any case, the method of surgical treatment of the coccygeal tract is always determined by the doctor individually for each patient.

Thus, in the chronic course of the disease, excision of the coccygeal tract is used using local or spinal anesthesia. This type of intervention is radical. In cases where the patient has an acute inflammatory process, for example, abscess formation, preference should be given to two-stage surgical treatment. The operation of removing the coccygeal duct is carried out in 2 stages: the first stage is opening the abscess, the second is excision of the coccygeal duct. The source of inflammation is cleaned of pus and hair, then the wound is loosely closed, leaving room for drainage of purulent discharge. The operation to remove the coccygeal passage can be performed on an outpatient basis. During the rehabilitation period, the patient will require observation by the attending proctologist and daily dressings.

After surgery, antibiotics and painkillers may be prescribed. After removing the bandage, it is recommended to take baths with antiseptic agents (furatsilin solution, chamomile infusion). Sitting and lifting weights are prohibited for a month after the intervention. After removing the sutures, a daily shower with thorough rinsing of the intergluteal fold is recommended. Within six months after surgery, depilation should be carried out in the surgical area at 2-week intervals.

At MedicCity, proctology is one of the priority areas. Our clinic is rightfully proud of its highly professional specialists and European-level diagnostic and treatment equipment. We possess all the most modern methods of treating proctological diseases, such as hemorrhoids, anal fissure and many others.