関: pilonidal sinus

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a closed sac that develops abnormally in some body structure

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胞嚢(ほうのう)

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/01/28 21:58:25」(JST)

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"Jeep seat" redirects here. For other uses, see Jeep.

A pilonidal cyst, also referred to as a pilonidal abscess, pilonidal sinus or sacrococcygeal fistula, is a cyst or abscess near or on the natal cleft of the buttocks that often contains hair and skin debris.^[1]

Signs and symptoms[edit]

Pilonidal cysts are often very painful, and typically occur between the ages of 15 and 35.^[2] Although usually found near the coccyx, the condition can also affect the navel, armpit or genital region,^[3] though these locations are much rarer.

Some people with a pilonidal cyst will be asymptomatic.^[4]

Pilonidal sinus[edit]

A sinus tract, or small channel, may originate from the source of infection and open to the surface of the skin. Material from the cyst may drain through the pilonidal sinus. A pilonidal cyst is usually painful, but with draining, the patient might not feel pain.

Causes[edit]

One proposed cause of pilonidal cysts is ingrown hair.^[5] Excessive sitting is thought to predispose people to the condition because they increase pressure on the coccyx region. Trauma is not believed to cause a pilonidal cyst; however, such an event may result in inflammation of an existing cyst. However there are cases where this can occur months after a localized injury to the area. Some researchers have proposed that pilonidal cysts may be the result of a congenital pilonidal dimple.^[6] Excessive sweating can also contribute to the cause of a pilonidal cyst. Moisture can fill a stretched hair follicle, which helps create a low-oxygen environment that promotes the growth of anaerobic bacteria, often found in pilonidal cysts. The presence of bacteria and low oxygen levels hamper wound healing and exacerbate a forming pilonidal cyst.^[7]

The condition was widespread in the United States Army during World War II. More than eighty thousand soldiers having the condition required hospitalization; ^[8] the average length of these wartime hospital stays was 55 days.^[9] The condition was termed "jeep seat" or "Jeep riders' disease", because a large portion of people who were being hospitalized for it rode in Jeeps, and prolonged rides in the bumpy vehicles were believed to have caused the condition due to irritation and pressure on the coccyx.

Treatment[edit]

Pilonidal cyst two days after surgery.

Treatment may include antibiotic therapy, hot compresses and application of depilatory creams.

In more severe cases, the cyst may need to be lanced or surgically excised (along with pilonidal sinus tracts). Post-surgical wound packing may be necessary, and packing typically must be replaced twice daily for 4 to 8 weeks. In some cases, two years may be required for complete granulation to occur. Sometimes the cyst is resolved via surgical marsupialization.^[10]

Surgeons can also excise the sinus and repair with a reconstructive flap technique, such as a "cleft lift" procedure or Z-plasty, usually done under general anesthetic. This approach is especially useful for complicated or recurring pilonidal disease, leaves little scar tissue and flattens the region between the buttocks, reducing the risk of recurrence.^[7]

A novel and less destructive treatment is scraping the tract out and filling it with fibrin glue. This has the advantage of causing much less pain than traditional surgical treatments and allowing return to normal activities after 1–2 days in most cases.^[11]

Pilonidal cysts recur and do so more frequently if the surgical wound is sutured in the midline, as opposed to away from the midline, which obliterates the natal cleft and removes the focus of shearing stress. An incision lateral to the intergluteal cleft is therefore preferred, especially given the poor healing of midline incisions in this region.

Differential diagnosis[edit]

A pilonidal cyst can resemble a dermoid cyst, a kind of teratoma (germ cell tumor). In particular, a pilonidal cyst in the gluteal cleft can resemble a sacrococcygeal teratoma. Correct diagnosis is important because all teratomas require complete surgical excision, if possible without any spillage, and consultation with an oncologist.

Etymology[edit]

Pilonidal means nest of hair and is derived from the Latin words for hair (pilus) and nest (nidus).^[2] The condition was first described by Herbert Mayoin 1833.^[12]^[13] R.M. Hodges was the first to use the phrase pilonidal cyst to describe the condition in 1880.^[14]^[15]

Notes[edit]

^ Klass, Alan (November 1, 1956). "The So-Called Pilo-Nidal Sinus". Canadian Medical Association Journal 75 (9): 737–742. PMC 1823328. Retrieved February 8, 2013.
^ ^a ^b "Pilonidal Cyst: Definition". Mayo Clinic. December 5, 2012. Retrieved February 8, 2013.
^ Rao, Amrith; Sharma, Mohit; Thyveetil, Mabel; Karim, Omer (December 2006). "Penis: An Unusual Site for Pilonidal Sinus". International Urology and Nephrology 38 (3–4): 607–608. doi:10.1007/s11255-005-4761-5. |accessdate= requires |url= (help)
^ Doerr, Steven. "Pilonidal Cyst". eMedicineHealth. p. 1. Retrieved February 8, 2013.
^ "Pilonidal Cyst: Causes". Mayo Clinic. December 5, 2012. Retrieved February 8, 2013.
^ da Silva JH (2000). "Pilonidal cyst: cause and treatment". Dis. Colon Rectum 43 (8): 1146–56. PMID 10950015.
^ ^a ^b Bascom, John; Bascom, Thomas (October 2002). "Failed Pilonidal Surgery". Archives of Surgery 137 (10): 1146–50. PMID 12361421. Cite uses deprecated parameters (help)
^ "Pilonidal disease. DermNet NZ". Retrieved 2007-11-18.
^ Abramson, Daniel J. (November 1978). "Outpatient Management of Pilonidal Sinuses: Excision and semiprimary closure technic". Military Medicine 143 (11): 753–757. PMID 101899. Cite uses deprecated parameters (help)
^ Prolonged delay in healing after surgical treatment of pilonidal sinus is avoidable
^ Fibrin glue in the treatment of pilonidal sinus: results of a pilot study. Lund JN, Leveson SH.Dis Colon Rectum. 2005 May;48(5):1094-6.
^ Lanigan, Michael (September 27, 2012). "Pilonidal Cyst and Sinus". Medscape. WebMD. Retrieved February 8, 2013.
^ Saad, Saad; Shakov, Emil; Sebastian, Vinod; Saad, Adam (2007). "The use of Wound Vacuum-assisted Closure (V.A.C.™) system in the treatment of Recurrent or Complex Pilonidal Cyst Disease: Experience in 4 Adolescent Patients". The Internet Journal of Surgery 11 (1). doi:10.5580/382. ISSN 1528-8242. |accessdate= requires |url= (help)
^ Hodges, RM (1880). "Pilonidal sinus". The Boston Medical and Surgical Journal 103: 485–586.
^ Kanerva 2000, p. 821

References[edit]

Kanerva, Lasse (2000). Handbook of Occupational Dermatology. Springer. ISBN 9783540640462.

External links[edit]

Wikimedia Commons has media related to Sinus pilonidalis.

Pilonidal.org – Pilonidal Support Alliance
Pilonidal Disease
Pilonidal Cyst - Types of treatment
Pilonidal Cyst complications
Images of pilonidal disease and treatment - www.learncolorectalsurgery.com
World Wide Wounds - in-depth information on the treatment and symptoms of the condition, with photographs.
Pilonidal sinus – NHS Direct Online Health Encyclopaedia

UpToDate Contents

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1. 殿間の毛巣病：臨床症状および診断 intergluteal pilonidal disease clinical manifestations and diagnosis
2. 殿間の毛巣病のマネージメント management of intergluteal pilonidal disease
3. 肛門周囲膿瘍：臨床症状、診断、および治療 perianal abscess clinical manifestations diagnosis treatment
4. 皮膚膿瘍に対する切開および排膿手技 technique of incision and drainage for skin abscess
5. Z形成術 z plasty

English Journal

Defect closure with "8-shaped crisscross tensile suture" technique.

Yeşiloğlu N1, Sirinoğlu H2, Yildiz K3, Akçal AÖ4, Turgut G5.
The Journal of surgical research.J Surg Res.2015 Feb;193(2):963-8. doi: 10.1016/j.jss.2014.09.003. Epub 2014 Sep 16.
BACKGROUND: Sutures and suturing techniques compose the basis of the surgery. Although many surgical methods such as the skin grafts or flaps has been described for the closure of large defects, proper primary suturing may sometimes yield very successful results and decrease the need of complicated
PMID 25277351

Primary wound closure with a Limberg flap vs. secondary wound healing after excision of a pilonidal sinus: a multicentre randomised controlled study.

Käser SA1, Zengaffinen R, Uhlmann M, Glaser C, Maurer CA.
International journal of colorectal disease.Int J Colorectal Dis.2015 Jan;30(1):97-103. doi: 10.1007/s00384-014-2057-x. Epub 2014 Nov 5.
PURPOSE: Off-midline procedures seem to be the best method of primary wound closure after excision of a pilonidal sinus. Primary wound closure with a Limberg flap was compared to secondary wound healing.METHODS: From January 2006 to July 2012, 102 patients with given informed consent (mean age 28 y
PMID 25367184

The diverse application of laser hair removal therapy: a tertiary laser unit's experience with less common indications and a literature overview.

Koch D1, Pratsou P, Szczecinska W, Lanigan S, Abdullah A.
Lasers in medical science.Lasers Med Sci.2015 Jan;30(1):453-67. doi: 10.1007/s10103-013-1464-5. Epub 2013 Oct 31.
We describe the diversity of indications for laser hair removal (LHR) therapy and compare our experience with the literature. Patients' case notes referred to the Birmingham Regional Skin Laser Centre between 2003 and 2011 for laser hair removal, with indications other than hirsutism, were reviewed
PMID 24173910

Japanese Journal

Pilonidal cyst : cause and treatment

SILVA JH.
Dis Colon Rectum 43, 1146-1156, 2000
NAID 30010799983

毛巣嚢胞あるいは毛巣瘻孔(Pilonidal Cyst or Sinus)の外科治療--とくにメチレンブル-添加オキシフル溶液の使用について

八木博司,植田英彦,瀬尾洋介
外科 39(8), p815-818, 1977-08
NAID 40000977491

含毛嚢胞(Pilonidal cyst)の3症例

斎藤篤
臨床整形外科 8(12), 1064-1069, 1973-12
NAID 40018604776

Pilonidal cyst(Sinus)あるいは一種の慢性膿皮症(Pyodermia chronica abscedens et suffodiens)に続発した扁平上皮癌の症例

山田瑞穂 [他]
日本皮膚科学会雑誌 82(5), 307-312, 1972-05
NAID 40018363541

Related Pictures

★リンクテーブル★

リンク元	「毛巣瘻」「毛巣嚢胞」

「毛巣瘻」

Pilonidal cyst
	Classification and external resources
	; Two pilonidal cysts that have formed in the gluteal cleft of an adult man.
ICD-10	L05
ICD-9	685
DiseasesDB	31128
eMedicine	emerg/771
MeSH	D010864

　　[★]

英: pilonidal sinus, piliferous sinus, coccygeal sinus
同: 毛巣嚢胞 pilonidal cyst、ジープ病 jeep disease、毛巣洞

[show details]

毛巣嚢胞 : 約 12,600 件
ジープ病 : 約 1,300 件
毛巣洞 : 約 14,300 件
毛巣瘻 : 約 36,500 件

概念

皮膚に刺さった毛の周辺で肉芽組織と扁平上皮で囲まれた瘻孔が形成されるものをいう。
仙骨部に多発し、特に臀部に多毛傾向のある若年男性に多発する。
治療は肉芽組織を切除する。

参考

1. 写真

http://www.dermis.net/bilder/CD198/550px/img0095.jpg

2. 写真

http://wikisurgery.com/images/b/bc/Pilonidal-sinus.jpg

3. 英語

http://www.kimayahealthcare.com/AilmentDetail.aspx?AilmentID=191&AboutID=1

「毛巣嚢胞」

　　[★]

英: pilonidal cyst
関: 毛巣洞、毛巣瘻

[1] Klass, Alan (November 1, 1956). "The So-Called Pilo-Nidal Sinus". Canadian Medical Association Journal 75 (9): 737–742. PMC 1823328. Retrieved February 8, 2013.

[Mayoclinic-2] "Pilonidal Cyst: Definition". Mayo Clinic. December 5, 2012. Retrieved February 8, 2013.

[3] Rao, Amrith; Sharma, Mohit; Thyveetil, Mabel; Karim, Omer (December 2006). "Penis: An Unusual Site for Pilonidal Sinus". International Urology and Nephrology 38 (3–4): 607–608. doi:10.1007/s11255-005-4761-5. |accessdate= requires |url= (help)

[emed2-4] Doerr, Steven. "Pilonidal Cyst". eMedicineHealth. p. 1. Retrieved February 8, 2013.

[title-Pilonidal_cyst._Mayo_Clinic-5] "Pilonidal Cyst: Causes". Mayo Clinic. December 5, 2012. Retrieved February 8, 2013.

[pmid10950015-6] Silva JH (2000). "Pilonidal cyst: cause and treatment". Dis. Colon Rectum 43 (8): 1146–56. PMID 10950015.

[Bascom-7] Bascom, John; Bascom, Thomas (October 2002). "Failed Pilonidal Surgery". Archives of Surgery 137 (10): 1146–50. PMID 12361421. Cite uses deprecated parameters (help)

[title-Pilonidal_disease._DermNet_NZ-8] "Pilonidal disease. DermNet NZ". Retrieved 2007-11-18.

[9] Abramson, Daniel J. (November 1978). "Outpatient Management of Pilonidal Sinuses: Excision and semiprimary closure technic". Military Medicine 143 (11): 753–757. PMID 101899. Cite uses deprecated parameters (help)

[10] Prolonged delay in healing after surgical treatment of pilonidal sinus is avoidable

[11] Fibrin glue in the treatment of pilonidal sinus: results of a pilot study. Lund JN, Leveson SH.Dis Colon Rectum. 2005 May;48(5):1094-6.

[emed-12] Lanigan, Michael (September 27, 2012). "Pilonidal Cyst and Sinus". Medscape. WebMD. Retrieved February 8, 2013.

[ispub-13] Saad, Saad; Shakov, Emil; Sebastian, Vinod; Saad, Adam (2007). "The use of Wound Vacuum-assisted Closure (V.A.C.™) system in the treatment of Recurrent or Complex Pilonidal Cyst Disease: Experience in 4 Adolescent Patients". The Internet Journal of Surgery 11 (1). doi:10.5580/382. ISSN 1528-8242. |accessdate= requires |url= (help)

[14] Hodges, RM (1880). "Pilonidal sinus". The Boston Medical and Surgical Journal 103: 485–586.

[isbn-3-540-64046-0-15] Kanerva 2000, p. 821

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pilonidal cyst