Epithelial coccygeal duct (ECX) is a congenital or acquired disease, which is a cavity with point exits on the surface of the skin. The pathology forms in the sacrococcygeal region under the layer of skin. The development of the inflammatory process in the cyst cavity leads to severe complications.
A coccyx cyst can be pilonidal (epithelial coccygeal duct) or dermoid. The disease is characterized by the absence of symptoms until the development of a purulent process. When the coccygeal passage is blocked, an abscess or phlegmon may develop. The infection process is accompanied by severe pain, fever, and it is difficult for the patient to turn, bend, or sit on a chair.
Surgical removal of a coccyx cyst is performed regardless of whether there are complications or not. At the Yusupov Hospital, a proctologist is treating the disease.
Causes
The causes of a pilonidal cyst are varied. These include lifestyle, injuries, and attitude to personal hygiene. The disease may be neurogenic in nature, associated with a decrease in immunity and other disorders. Congenital pilonidal cyst of the coccyx is formed in the early embryonic period. The most common pilonidal cyst of the coccyx occurs in men. Men's sebaceous and sweat glands work more actively, and men often experience excess hair growth in the sacrococcygeal region.
Between the ages of 16 and 25, abnormal hair ingrowth into the epithelium often occurs, which leads to the formation of a coccyx cyst. An injury or scratch may be accompanied by infection of the cyst and the development of an inflammatory process. Features of the anatomical structure of the sacrococcygeal region also influence the development of ECC. The coccyx cyst contains epithelial cells, hair, secretions of the sebaceous and sweat glands. The cyst cavity ends a few centimeters from the anus.
Often, infection of the cyst cavity occurs due to non-compliance with hygiene rules. A sedentary lifestyle and sedentary work are one of the reasons for the development of pathology. Infection entering the cyst cavity leads to blockage of pinholes in the skin, exudate no longer leaves the cavity - all these factors lead to the development of an abscess and the spread of the inflammatory process to the surrounding tissue.
Symptoms
The disease is characterized by the absence of symptoms until the development of a purulent process.
A coccygeal cyst is a round formation. It is localized in the area of the gluteal fold, 5-10 cm above the anus. The size of the cyst gradually increases, which is accompanied by pathological symptoms.
Among the most characteristic symptoms are:
- discomfort and pain in the gluteal fold, increasing with movement and sitting;
- swelling in the sacral area, in some cases involving the perineum;
- hyperemia of the skin in the area above the coccyx;
- opening of the embryonic passage;
- purulent discharge (with a purulent cyst of the coccyx);
- increased body temperature;
- near the first one, the opening of secondary passages can be observed.
Symptoms of epithelial coccygeal cyst
Often a congenital disease does not manifest itself for years. Symptoms occur only when the hole is injured or blocked from the outside:
- swelling of the coccyx area, tissue redness;
- sensation when walking and sitting of the presence of a foreign body in the intergluteal fold;
- enlargement of the external opening, secretion of mucus from it;
- the appearance of holes in the affected area during periods of exacerbation (mucus comes out through them, and scars then form in their place);
- elevated body temperature.
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Diagnostics
To carry out diagnostic measures for identifying a coccyx cyst, the Yusupov Hospital has all the necessary modern equipment that allows you to detect pathology in the shortest possible time and with maximum accuracy.
The main methods for diagnosing coccyx cysts include the following instrumental studies:
- sigmoidoscopy - for detailed visualization of the intestinal mucosa and determination of the localization of the pathological formation;
- probing the cyst - allows you to identify the canal of the coccygeal passage, the place where it enters the intestine;
- ultrasound examination - prescribed to clarify the localization and spread of the pathological process;
- X-ray of the sacral area with contrast;
- computer or magnetic resonance imaging.
DIAGNOSIS OF VIOLATION
If a coccyx cyst occurs, treatment is carried out after a detailed examination of the patient. Specialists at Medical Plaza MC carry out high-quality diagnostics of the epithelial coccygeal tract, which helps to determine with 100% accuracy the form, stage of the disease, and important features of its course.
Detection of a pilonidal cyst does not cause any difficulties. If the pathology is uncomplicated, it can be diagnosed through a visual examination of the folds between the buttocks and the existing primary openings. If the patient has progressive inflammation and numerous fistulas, a diagnosis of “complicated epithelial coccygeal tract” is made.
In some cases, doctors resort to additional diagnostic procedures:
- palpation of the coccygeal and sacral vertebrae (digital examination of the anus);
- Ultrasound of soft tissues;
- sigmoidoscopy;
- probing the epithelial coccygeal duct;
- fistulography (x-ray examination of fistula tracts).
The listed methods allow you to clarify the diagnosis. They also help to exclude the presence of certain pathologies (paraproctitis, rectal fistula, osteomyelitis).
If a coccyx cyst is detected, the price of treatment in our clinic will be determined by many factors. The patient’s age and the presence of concomitant diseases must be taken into account.
Treatment
Currently, there is no “gold standard” in the treatment of epithelial coccygeal duct. Treatment without surgery is impossible. There are several methods of surgical intervention. The choice of treatment method depends on many factors. These include:
- individual characteristics of the patient’s body;
- prevalence of the inflammatory process;
- features of the anatomical structure of the sacrococcygeal region.
During surgery, proctological surgeons at the Yusupov Hospital completely remove the cyst and all canals (passages). It is important to carry out a planned operation - this increases the effectiveness of treatment.
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TYPES OF PATHOLOGY
According to the clinical classification, there are four types of the disease:
| Uncomplicated epithelial coccygeal tract | It occurs latently, without pronounced symptoms. |
| Acute form of inflammation | It has two stages - infiltration and the stage of formation of a purulent abscess. |
| Chronic form of pilonidal cyst | It is characterized by the presence of three stages - infiltration, recurrent abscess, purulent fistula. |
| Remission of the inflammatory process | It occurs with weakening or complete disappearance of negative symptoms. |
Contact a specialist on time! Only with the help of timely and high-quality medical care will it be possible to avoid the transition of the disease to an acute or chronic stage.
Types of operations to remove coccyx cysts
There are several options for performing surgery to remove a coccyx cyst:
- the cyst and tracts are completely excised, the wound is not sutured;
- the cyst and tracts are completely excised, and subsequent suturing of the wound is performed;
- The cyst and tracts are excised, and subsequent skin grafting is performed.
The duration of surgery is usually from 20 to 60 minutes, depending on the volume of the operation. In addition, the length and number of epithelial ducts are taken into account.
Surgery can be performed in several ways. For this purpose, various approaches, surgical techniques and cutting instruments are used. For example, operations can be performed using a conventional scalpel, radio knife or laser.
Most often, for common forms of the epithelial coccygeal tract, radical open surgery is performed. This method leads to scar formation, a cosmetic defect, and is characterized by a long rehabilitation period, but a lower risk of postoperative relapses.
The chronic form of coccyx cyst is treated at the Yusupov Hospital using a two-stage radical operation. Radical surgery to remove a pilonidal cyst is performed using local or spinal anesthesia. At the first stage, the abscess in the cyst cavity is opened, the cavity is sanitized, and a drainage system is installed. After the inflammatory process subsides, the doctor carries out the second stage of treatment - excision of the epithelial coccygeal duct with removal of all affected tissue. Then the wound is sutured using one of the methods. After surgery on a coccyx cyst, the patient requires wound care, daily treatment and dressing.
What it is?
Some pathologies of the musculoskeletal system are characterized by the fact that, even if they are already present in the body, they do not make themselves felt for a long time. Moreover, a number of them are caused by hereditary factors or features of body formation even at the stage of intrauterine development. For example, a coccygeal cyst appears during the period when the baby is fully developing inside the mother. It is formed at a time when the active creation of tissues of the coccyx and sacrum occurs . But it does not always appear, but only if these tissues are formed incorrectly.
Epithelial coccygeal tract
The mechanism of formation of this cyst is as follows: in the area of the fold between the buttocks there is an elongated narrow cavity called the coccygeal duct. From the inside, it has no connection with the coccyx and is lined with epithelial tissue. However, there are a couple of tiny holes on the surface of the skin that are not visible to the eye. They are called the primary epithelial duct, and sweat and sebaceous gland secretions can escape through it. It is interesting that the coccygeal passage is formed from the rudiments of the tail, which disappeared in the process of evolution in humans, but begins to develop during embryonic development. However, it disappears under the influence of special hormones - the process seems to go in the opposite direction. If at this time any failure occurs, then the process is not completed completely, and this same epithelial tract is formed, starting in the fatty tissue and ending in the area of the intergluteal area on the surface of the skin.
Coccygeal tract
A cyst is formed in case of blockage of the primary passage or lack of hygiene - inflammatory processes begin inside the cavity. By itself, it represents a cavity-capsule. Over time, without proper treatment, inflammation will turn into suppuration. After some time, a fistula will appear on the skin - the so-called secondary hole.
On a note! Coccyx cysts usually develop in men aged 15-40 years, but women are not at risk. But representatives of the fair sex can still develop a cyst.
Table. Types of coccygeal cysts.
| Type | Description |
| Epithelial course | It is formed in the upper part of the epithelium, in its upper layers. |
| Dermoid cyst | It develops under the skin, but is located deeper than the epithelial tract. It differs from it in that it does not have a hole going out - only a tumor (fortunately, benign) is visible on the skin. The tumor may begin to fester. The cyst is growing and requires urgent treatment. |
| Pilonidal sinus | Develops against the background of inflammation of the hair follicle or due to abnormal hair growth on the skin (for example, ingrown hairs). |
| Pilonidal fistula | This is the last form of cyst. There is abundant suppuration in the soft tissue area. Fluids are released through an opening in the skin. |
Diagram of a coccyx cyst
Important! A cyst is not a disease that you can give up on. This is a benign tumor that can degenerate into malignant if it is not treated with due attention.
Examination before surgery
Before the operation, the patient undergoes an examination, which includes:
- examination by a proctologist;
- sigmoidoscopy;
- colonoscopy;
- anoscopy according to indications;
- ECG;
- fluorography;
- general blood analysis;
- general urine analysis;
- blood chemistry;
- coagulogram;
- blood for HIV, hepatitis B and C, RW;
- Ultrasound of sacrococcygeal tissues;
- MRI of the lumbar region;
- fistulography.
Indications for surgery for presacral cysts and tumors
The indication for surgical intervention is the very presence of a teratoid neoplasm (presacral cyst), even in the absence of clinical symptoms, since purulent complications often occur or malignant degeneration of teratomas occurs.
Diagnosis of presacral cysts and tumors
Video from the operating room. Presacral cyst excision
As a rule, a presacral cyst is detected on MRI or ultrasound of the pelvic organs measuring 2 cm or more. If the cyst is located low, it can be palpated by the doctor during vaginal or rectal examination.
Types of approaches in the surgical treatment of presacral cysts and tumors:
- laparoscopic access;
- perineal access;
- transanal access
- transvaginal access.
To correctly select the method of operation, you must send me a complete description of the ultrasound of the pelvic organs to my personal email address, indicate your age and main complaints. Then I will be able to give a more accurate answer to your situation.
Of all the possible approaches, the most modern, less traumatic, cosmetically justified and effective is the laparoscopic approach.
Indications
Surgeries to remove coccyx cysts with a laser are performed in Moscow at the Yusupov Hospital. Treatment of coccyx cysts with laser can be done in two ways - open and closed. Currently, minimally invasive methods are used more often. This is due to the advantages of this treatment method. The epithelial coccygeal duct (pilonidal cyst) is a potential source of development of inflammatory processes. The presence of a cyst increases the risk of developing an abscess or cellulitis. Proctologists recommend radical removal of the ECX. Radical removal surgery takes up to 30 minutes. Doctors perform the operation using various methods, including those developed by foreign colleagues. During the operation, local, general or combined anesthesia is used.
Laser surgery allows you to avoid the development of bleeding, complications, and significantly reduce and close the cyst cavity. When a cyst is removed with a laser beam, blood vessels coagulate, which significantly reduces the risk of bleeding and infection. Open surgery is performed for advanced coccyx cysts when there are complications. The tracts of the coccygeal cyst are removed along with the surrounding tissues. After removal of the cyst, the edges of the wound are sutured to the bottom of the wound, which avoids relapse of the disease and postoperative complications.
The rehabilitation period is long, the patient experiences pain in the coccyx area, and cannot be in a sitting position for a long time. A closed operation is performed with the removal of the ECX, the doctor stitches the primary hole, leaving the secondary one with drainage for the outflow of exudate. When performing an operation using a closed method, the risk of developing a purulent process increases. This method is used for uncomplicated cysts, during planned surgery. The recovery period is significantly reduced, the patient experiences less discomfort and pain.
SIGNS AND SYMPTOMS OF THE DISEASE
A fistula under the coccyx may not appear for a long period of time. The first symptoms can occur during puberty, characterized by puberty in adolescents. In the lumen of the coccygeal passage, the hair follicles are activated, and waste from the activity of the sweat and sebaceous glands accumulates. The abundance of microflora in the area of the passage itself and in the skin fold between the buttocks is explained by the close location of the anus.
If the primary openings do not provide adequate drainage, the risk of inflammation increases. In this case, the walls of the coccygeal tract begin to collapse, the pathological process affects the fatty tissue, and a purulent abscess forms. Some ulcers reach large sizes, break through the skin and form a secondary opening (purulent fistula of the coccyx).
In patients with the acute form of a pilonidal cyst, the following symptoms are observed:
- pain, swelling of tissues in the area of pathology development;
- redness of the primary openings of the fistula;
- swelling around the tailbone;
- discharge of large volumes of pus;
- increased body temperature;
- inability to sit or lie down.
A fistula in the coccyx area can significantly worsen the patient’s general well-being. In the absence of adequate therapeutic measures, the pathology can lead to general intoxication of the body, requiring emergency medical care.
Contraindications
Removing a coccyx cyst using a laser is not always possible. Contraindications for this research method include:
- tumor formations of various localizations;
- a history of diseases of the hematopoietic and immune systems;
- cardiovascular pathology;
- renal and liver failure;
- coccyx cyst complicated by an abscess;
- acute infectious and inflammatory diseases.
Postoperative period
The rehabilitation period depends on the method of surgical treatment. After the operation, the patient has been bothered by pain in the coccyx area for a long time. The doctor prescribes painkillers. The scar formed after surgery can cause pain when sitting and exercising. Additionally, the doctor may prescribe physiotherapeutic procedures and drug therapy.
A long period of rehabilitation and daily wound care also cause discomfort for the patient. When choosing a method of performing a surgical operation, the doctor tries to avoid the development of postoperative complications, relapse of the disease, and a long period of rehabilitation. Postoperative disease prevention is of great importance.
Prevention of coccyx cysts begins immediately after radical surgery. The patient should follow all the doctor’s recommendations:
- thorough hygiene procedures;
- wearing loose underwear;
- adoption of a sitting position after three weeks;
- exercise no earlier than a month after surgery;
- regular visits to a proctologist;
- maintaining an active lifestyle after complete healing of the postoperative wound;
- regulation of nutrition - introduction into the diet of foods recommended by a doctor on an individual basis.
In addition, in order to avoid the development of unwanted complications, patients in the proctology department of the Yusupov Hospital in the postoperative period are prescribed antibacterial therapy using modern broad-spectrum antibiotics, as well as physiotherapeutic methods of treatment that ensure rapid wound healing.
Patient recovery after removal of ECC with a scalpel.
To ensure that the ECC heals faster after surgery and there are no infectious complications, the patient is prescribed antibiotic therapy, physiotherapeutic procedures, and dressings using anti-inflammatory ointments. Growing hairs are removed around the wound as necessary so that they do not accidentally get into it. On the first day after surgery for ECX, the patient must remain in bed. If the doctor deems it necessary, he will be kept in the hospital. You can only get up on the second day. Doctors usually allow you to walk after four days. Until the stitches are removed (usually after ten days), the patient should not sit, perform strenuous physical work, or lift heavy objects. Some patients experience recurrence after ECC removal. It may be due to incomplete removal of purulent accumulations, fistulas and holes, as well as the patient’s ignorance of the rules that he had to strictly follow.
Rice. 2. Remote ECX during surgery.
Removal of the epithelial coccygeal duct in Moscow
Doctors at the Yusupov Hospital use various methods to treat coccyx cysts. A proctological check-up program has been introduced for patients. Based on the results of the examination under the proctology program, the patient receives a report on his state of health, recommendations on nutrition, lifestyle, and will be able to undergo treatment for diseases in the hospital. At the Yusupov Hospital, the patient will be in a comfortable hospital room under round-the-clock supervision of medical personnel. You can make an appointment with a doctor by phone.
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