Epithelial coccygeal passage

Epithelial coccygeal passage , in another way this disease is called a coccyx cyst, dermoid cyst, coccyx fistula, etc. Americans traditionally talk about the pilonidal sinus. The essence of this disease lies in the fact that always with an epithelial coccygeal course strictly along the mid-gluteal line at a distance of traditionally 4–7 cm from the edge of the anus, there is at least one opening. It can be dotted, barely noticeable, and sometimes wide, in the form of a funnel. This is, as it were, the “beginning” of the coccygeal passage. The sick or ill, traditionally young people, can live for years without being aware of the presence of the disease.

For various reasons, such as, for example, an injury to the coccyx, cooling, a flu-like condition, and sometimes for no apparent reason, an infection through this so-called. the primary hole penetrates deep into the tissues and the inflammatory process begins in the coccyx and sacrum. There are pains, swelling, sometimes redness in the projection of the primary opening, or on any side of it (above, below, on the right, on the left), which force the patient to consult a doctor. In such cases, they speak of the acute stage of the disease, and the patient, as a rule, learns about his disease for the first time. An abscess in the coccyx area is opened by doctors, or it opens on its own, with all this the pain disappears, relief begins, but subsequently a secondary fistulous opening is formed at the site of the opened hole, from which purulent contents can periodically be released.

In some cases, after opening the abscess of the sacrococcygeal region, the wound closes without the formation of a fistula and an imaginary period of well-being begins. The focus of a dormant chronic infection remains in the epithelial coccygeal passages, which traditionally gives a second exacerbation with the formation of an abscess, and sometimes phlegmon. These exacerbations can occur for months, sometimes for several years. In the intervals between exacerbations, the patient may be disturbed by periodic dull pains or discomfort in the coccyx, especially when sitting, sometimes discharge from the primary openings of the course. In any case, there remains a focus of chronic inflammation.

With a long refusal of the patient from radical treatment, inflammatory changes in the epithelial course and surrounding tissue can lead to the formation of multiple secondary fistulas that open far enough: in the sacrococcygeal region, on the perineum, on the scrotum, in the inguinal folds. In these cases, pyoderma often joins, and sometimes actinomycosis (fungal) lesions, which greatly complicate the course of the disease. During the operation, these patients have to excise the affected tissues over a large area, and sometimes it is necessary to divide the operation into several stages. There is another serious complication of a long-term untreated epithelial coccygeal passage. The latter with a long illness over 10 years can become malignant. It doesn’t happen very often, but it does happen.

Treatment of the epithelial coccygeal passage today is only surgical, and only radical surgical intervention can completely cure the patient. The operation consists in removing the main epithelial coccygeal passage along with all the primary openings and with all its branches. To date, there are a number of surgical interventions, the purpose of which, on the one hand, is to excise the entire pathological focus, on the other hand, to partially suture the wound, or by suturing the edges of the wound to the bottom in order to minimize the overall healing period. Operations are performed after examination and preparation of the patient with the use of full anesthesia (epidural-sacral anesthesia).

In the postoperative period, the patient stays in a day hospital for several hours until the general condition is completely normalized with a mandatory dropper and anesthesia. Usually, 1–1.5 hours after the operation, the patient begins to walk, drinks enough water, and urinates on his own. After 6-7 hours, the patient is re-examined, the bandage is changed and fixed, after which, accompanied by a car, he goes home. In the future, up to the complete and final healing of the wound, the patient is under the supervision of doctors.

Complex, perennial forms of the epithelial coccygeal passage with many fistulous passages, streaks, infiltrates are operated on in a hospital.

In normal cases, the operation of the coccygeal passage is easily tolerated by patients. Complete healing of the wound traditionally occurs within a month after the operation, however, the ability to work is restored much earlier – from 1 to 3 weeks, depending on the nature of the work.

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