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I am a 44 year old male. About 25 years ago I had pilonidal cyst near the tail bone which I had surgically removed. They removed a wedge about 3" long, 1" wide and 3" deep. It took over three months to slowly close up from within. It has not come back again. However, three months ago, I had an abscess between the Anus and Testicles that got inflamed very fast (within 24 hours, it was the size of golf ball) without draining and was very painfull. They cut and drained it. It took about two weeks to heal. The surgeon told me people who have had Pilonoidal cysts before are prone to these type of abscesses. The abscess went down and completely healed within two weeks. A month ago, the abscess swelled up again in the same exact spot. They cut and drained it again and it healed up within two weeks. After it healed they felt around for any cyst they could feel to go after but felt nothing. I could not even feel anything under the skin in that area. Well, yesterday, in the same exact location, the abscess started to come back. Today they just cut and drained it again.
My questions are as follows:
1) Do these abscesses have anything to do with the Pilonoidal cyst? Could these abscesses be the start of another Pilonidal cyst? Do pilonoidal cysts only occur at the tailbone area or do they occur in other areas such as between anus and testicles?
2) After the abscess heals this time, if there is still no sign of any cyst, do they have to do exploratory surgery to find out what is going on or what do you do besides wait and see?
In Reply to: Pilonidal Cyst and recurring abscess posted by Fred on April 08, 2003 at 16:25:17:
Hi, Fred.
Once you understand the embryological cause of a Pilonidal problem (archives) you will understand how a pilonidal sinus can extend as far as a foot away from where they originate at the tip of the tailbone.
This sounds very suspicious to me. All they have to do is send a piece of the removed tissue to the lab to make the diagnosis. If this has not been done, why not? I can excuse the first time and perhaps even the second.
If this is a simple sebaceous cyst, it needs to be removed INTACT when it is not infected.
Walt
In Reply to: Re: Pilonidal Cyst and recurring abscess posted by Walt Stoll on April 09, 2003 at 08:50:00:
I am not sure what tissue you are talking about to be removed and sent to the lab. The Surgeon told me that there was nothing that could be excised. He said the only thing to do was to cut the skin over the abscess and drain it. I had a follow up examination after the second abscess had completelly healed because the doctor wanted to check for a cyst, but none was found. The third time I was at his office within 12 hours of feeling it come on, and he still could not detect any cyst to be excised. In the meantime, he cut and drained the abscess again. Now three days later, the area is become swollen and painfull again. I will be going back tomorrow if the swelling does not go down overnight.
Please clarify what tissue sample I can ask him to take since he has found no cyst. Thanks.
In Reply to: Re: Pilonidal Cyst and recurring abscess posted by Fred on April 10, 2003 at 22:16:23:
Hi, Fred.
At least half of pilonidal problems are sinuses and not cysts. Any pilonidal surgery HAS TO remove tissue or they are not treating it as a pilonidal problem. No wonder your problem is recurring. In my opinion you need a better set of docs who understand the problem.
Walt
In Reply to: Re: Pilonidal Cyst and recurring abscess posted by Walt Stoll on April 11, 2003 at 10:48:36:
Dr. Stoll:
I went back to the surgeon I have been seeing because the abscess had swollen again eventhough it was lanced and supposedly draining. I told him that I had been reading about other people on line that have similar problem and treatments that range from lancing to major surgery. He said that since all three abscesses have been in the same area, he wants to schedule me for major surgery where he would remove a large enough section of tissue and allow it to heal over time from inside out. He called it "Sectional Perineal Fistula". Is this what you were talking about? How do they know how much tissue to remove? Can they visually see the sinuses you were talking about? If the abscess was off center towards the right upper leg, do they remove tissue just from that side or do they have to remove tissue from both sides?
Thanks,
Fred
In Reply to: Re: Pilonidal Cyst and recurring abscess posted by Fred on April 14, 2003 at 23:58:50:
Hi, Fred.
Your concerns in order:
1. Yes.
2. They do not know. They just remove a lot and hope.
3. No. I remember when I used to assist at this surgery, if the surgeon could find one sinus he might inject methylene blue (a dye) into the sinus and see where it lead.
4. Just to that side, although it could be extending to both sides, the odds are that it is only to one side.
Hope this helps.
Walt
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