Treatment of epithelial coccygeal path
The epithelial coccygeal path is a congenital pathology, the cause of which is the development of the caudal part of the embryo.With her in the mezhyagodichnoy fold just above the anus under the skin formed epithelialized channel, heading toward the coccyx.
In most cases, the length of the canal is 2-3 cm. It is not directly connected with the coccyx, but ends blindly in the subcutaneous layer of the cellulose.This pathology is diagnosed quite often.
Note: some time ago, some experts called the pathological direction of hair growth( as it grew into the skin and the subsequent formation of a cystic neoplasm) as the cause of the path.So there was another name for this coccygeal path: the hairy cyst.Contents: Classification Symptoms epithelial-coccygeal Stage complicated diseases Diagnosis Treatment of epithelial-coccygeal Possible complications and consequences of the disease Preventing complications
According to the adopted classification distinguishes two kinds of epithelial coccygeal:
- complicated( when infected with microorganisms).
Note: inflammation of the pilonidal sinus can be both acute and chronic.
For more information on the classification of the disease you get by looking at the video review:
If there is a uncomplicated pathology, its sole clinical manifestation is the presence of holes near the coccyx in the crease between the buttocks.Often a bunch of hair emerges from the canal.This form of the disease can not fail to make itself felt for a long time( until reaching adulthood).
complication epithelial-coccygeal, wherein inflammation develops bacterial etiology accompanied by the appearance of symptoms such as:
- local pain syndrome( near coccyx);
- skin tightening around the canal:
- hyperemia of the skin in the interannual fold;
- discharge from the canal( pus or sour);
- increased fatigue;
- general deterioration of well-being;
addition infection specific microflora inhabiting the anus, cause inflammation of the epithelial-pilonidal cyst can become a trauma( such as bruised tailbone).
A significant part of the clinical symptoms is due to general intoxication of the body.
Important: most complications develop during adolescence, when activated hair growth in the anus, and sebaceous and sweat glands secrete an increased amount of secretions.In some cases, even a blockage of the coccygeal can be possible.
Stage complicated disease
Note: one of the factors predisposing to complications in the presence of epithelial-coccygeal often becomes too thick body hair sacrococcygeal area.
In the case of acute inflammation, a painful compaction of a rounded shape around the course begins.The integuments in the projection of the focus are hyperemic.Then an abscess forms in the area of compaction.
If the inflammation becomes chronic, then first there is a condensation, then an abscess that reappears a short time after treatment.
Note: dissection of the abscess can be spontaneous( spontaneous).Emptying the purulent focus helps to reduce or even disappear the symptoms of inflammation.But the chronization of the process of inflammation of the epithelial-coccygeal passage with the formation of a draining fistula is not excluded.
The stages of remission alternate with relapses.Possible outcome is the formation of fistulous courses of different localization;Through them, the purulent focus is drained.A complete remission can also be observed, in which the fistula is not formed, but the inflammation completely stops.
The presence on the patient's body of epithelial primary holes of characteristic localization is considered so-called.Pathognomonic sign, so in most cases, the diagnosis is not difficult.
The formation of fistula at the site of suppuration in a complicated course allows to consider this diagnosis as fully confirmed.
The specialist needs to carefully collect an anamnesis in order to clarify the diagnosis.The proctologist examines the complaints and finds out when the first symptoms appeared and how they changed with time.It is established whether one of the next of kin is suffering from a similar disease.This circumstance is of interest, since hereditary predisposition to the development of the epithelial-coccygeal path is often noted.
There is also an anamnesis of life in order to establish the living conditions and characteristics of work.Also, the patient finds out what diseases he suffered, and what chronic pathologies are present at the time.
The doctor examines the interannual fold and performs instrumental research - probing the pilonidal sinus in order to determine the extent and direction.
During the examination, finger examination of the rectum is performed to determine the presence or absence of fistulas, as well as to exclude other pathologies.Particular attention is paid to the state of crypts, since it is in one of them that a fistulous opening can be found.Additionally, palpation of the vertebrae through the back of the intestine is required to determine the possible pathological mobility.
Often, an instrumental examination is required - a sigmoidoscopy.It makes it possible to identify the presence of inflammatory changes in the mucous membranes, purulent foci and formed fistula in the intestine.If you detect any alarming changes, you may additionally require an irrigoscopy or a colonoscopy, but these methods are rarely used for examination.
In doubtful cases, to differentiate the coccygeal path from the fistula of the rectum, X-ray examination is used - fistulography.The technique assumes introduction of a radiopaque substance in the fistula to determine its correlation with the intestinal crypts.
In some cases, in the diagnosis of the epithelial-coccygeal pathway, it is necessary to differentiate the congenital pathology from:
- preseracal teratoma;
- of osteomyelitis;
- rear meningo;
- coccyx cysts.
Teratomas( tumor neoplasms) are located between the sacrum and the rectum wall;They are characterized by the presence of a stroke with a funnel-shaped epithelial opening at the back of the anus.Dense or tugoelasticheskie formation are revealed in the course of palpation research.To clarify the nature of pathology allow fistulography and ultrasound.
Osteomyelitis is often accompanied by the formation of purulent fistula.When palpation, the abnormal mobility of the vertebrae of the coccygeal and sacral region is detected and the swelling of the dough-like consistency in the lumen of the intestine is determined.Ultrasound and X-ray can confirm the diagnosis of "osteomyelitis".The presence of a fistulous course requires contrast radiography.
The posterior meningocele is defined as the oval elevation of the densely elastic consistency, localized in the cross-sagging fold.In this disease, primary strokes are not detected, and during the history of the patient, dysfunction of the pelvic organs( usually incontinence) is usually detected.In this case, a consultation of a neurosurgeon is required.
Epidermoid cysts in the absence of complications are mobile and completely painless for palpation.When suppuration, they may have a similarity to the coccygeal course, but in a careful examination, the absence of characteristic primary openings is determined.
After a medical history and examination, the patient with a confirmed diagnosis is sent to the surgeon for additional consultation and planning of treatment activities.
Treatment of epithelial-coccygeal path
Treatment is performed in specialized coloproctological departments of the hospital.
The only method to eliminate pathology and prevent possible complications is surgical intervention.
Excision of the epithelial-coccygeal path
As indicated in the treatment of the epithelial-coccygeal stroke, a palliative operation can be performed, which involves only opening and draining the abscess, which leads to remission of the disease.
Complete recovery allows only radical intervention, during which the canal walls are completely removed, tissues are excised to the coccygeal fascia, and the wound is closed tightly.
A scheduled operation is performed to treat an uncomplicated epithelial-coccygeal course.If acute purulent inflammation develops, then urgent surgical intervention is often required.In the inflammatory process of moderate activity and the absence of a formed abscess, operative treatment is carried out in one stage.If there is an abscess in the first stage, it is shown to open it and ensure the outflow of the contents, and only as far as relief of acute symptoms is concerned - radical excision and suturing of the stroke.
Note: is advisable to operate the epithelial coccygeal in a planned manner, until complications develop.In this case, the recovery period after the intervention is significantly shortened, and the healing proceeds smoothly without the formation of significant scars.
Conservative treatment is indicated to reduce or arrest symptoms of inflammation of the epithelial-coccygeal pathway.The patient is prescribed vitamin therapy, course antibiotics and NSAIDs, as well as physiotherapy procedures.For topical application in the postoperative period, gels and ointments are recommended, which include components that accelerate the healing and recovery of soft tissues.
Possible complications and consequences of the disease
The formation of fistulas is considered to be one of the most common complications of chronic inflammation in the epithelial-coccygeal course.
Variants of pathology location:
- perianal area;
- Crypts of the rectum;
- inguinal folds;
- lumbosacral region;
- pelvic organs;
- crotch area;
- anterior abdominal wall;
Important: if the course has already inflamed at least once, but then the patient's condition has returned to normal, then it does not go into full recovery until radical intervention.
If the inflammatory process affected the coccygeal vertebrae, development of purulent osteomyelitis is not excluded.In some cases, purulent lesions of the skin around the fistula( pyoderma) are noted as a complication of the epithelial-coccygeal course.
The most difficult to treat fistulous pyoderma with multiple secondary strokes.Fistulas in the lumbosacral, perineal and coccygeal regions are connected to each other in the system.
Inside the fistula, hair can grow, and often a significant amount is present:
- secretion of sebaceous glands,
- slipped epithelium,
- purulent discharge.
During the operation, the surgeon has to perform excision of the affected skin over a large area, otherwise it will be impossible to achieve recovery and avoid relapse.
Some researchers call a long chronic inflammatory process against the background of the epithelial coccygeal pathway as one of the possible causes of squamous cell carcinoma.
Prophylaxis of complications
A 100% guarantee for the prevention of the development of inflammation can only be provided by a timely and radical surgical intervention.
In the postoperative period, in order to avoid complications, it is recommended to exclude significant physical exertion, strictly observe the basic rules of personal hygiene, and also refuse to wear tight clothing, the seams of which can rub the area of the postoperative scar.
Stepanenko Vladimir, Surgeon