Chapter 92

Pilonidal disease was first described in 1880 by Hodges.1 He used the term “pilonidal sinus” to describe a chronic infection that contained hair and was usually found between the buttocks. “Pilonidal” comes from “pilus” or hair and “nidus” or nest. It literally means “nest of hair.” The condition did not receive much attention until it became a significant problem in the armed services around the time of World War II. In 1940, in the United States Navy, the number of sick days caused by pilonidal disease and its complications exceeded those of either syphilis or hernias.2 The term “jeep disease” was coined by Buie in 1944.3 It related the condition to drivers and passengers of jeeps.

Pilonidal sinus disease primarily affects Caucasian males. Blacks are infrequently affected. The condition is rare in Asians and Indians. Males are affected three times as frequently as females. The condition is prevalent from the onset of puberty to young adulthood. It is unusual after the age of forty. The peak age of incidence is 21 years. The increased incidence in adolescents and young adults is attributed to hormonal effects of increased hair on the torso, increased activity of sebaceous and sweat glands, fat deposition on the buttocks, and deepening of the gluteal cleft. Other risk factors may include hirsutism, obesity, and poor personal hygiene. Repeated trauma to the area may also contribute to the formation of pilonidal disease. There is an increased prevalence in drivers and others with occupations requiring long periods of sitting.4,5

Patients with pilonidal sinus disease may present with mild discomfort and a chronically draining sinus in the upper gluteal region. Others may note sinuses or pits that are asymptomatic. Approximately 50 percent of patients with symptomatic pilonidal disease will present acutely with severe pain and disability indicative of a pilonidal abscess that necessitates incision and drainage.6,7 Inspection will reveal one or more midline sinus tract openings, often with protruding tufts of hair. The area will be tender, erythematous, and indurated when an abscess is present. Fluctuance and swelling may not be readily appreciated. The sinuses may be quite extensive depending upon the chronicity of the disease process prior to presentation.

A pilonidal sinus consists of a characteristic midline opening, or series of openings, in the upper aspect of the gluteal cleft and approximately 4–5 cm from the anus (Figure 92-1). The skin enters the sinus giving the opening a smooth edge. This primary tract leads into a subcutaneous cavity that contains granulation tissue and often a nest of hairs (Figure 92-2). The hairs may be seen projecting through the skin opening. Many sinuses have lateral or secondary openings (fistulas) extending from the pilonidal abscess (Figure 92-2).

###### Figure 92-1

Pilonidal sinuses occur in the midline, approximately 4 to ...

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