The epithelial coccygeal passage is a narrow channel in which the sebaceous glands, hair follicles are located and which is lined with epithelium. On the skin, it opens with several primary holes in the zone of the intergluteal fold. Their number can vary from one to several. This pathology has many synonyms: pilonidal, epithelial, pilar cyst, epithelial immersion, sacrococcygeal fistula, posterior navel.
Concept
Epithelial coccygeal passage ends blindly in the subcutaneous tissue. The skin has primary holes that appear when a pathology occurs.
Their blockage and mechanical injuries lead to the fact that the contents are delayed in the lumen of the course, which causes inflammation. As a result of this, the passage expands, its wall collapses, and fatty tissue is involved in the process. The resulting abscess can reach large sizes, after which it breaks through the epithelium, formingexternal opening of a purulent fistula, classified as secondary.
This pathology is congenital. However, patients may be unaware of the presence of such a disease for a long time. In the so-called cold period, symptoms of the disease do not appear, or there may be anal itching, moisture in the epithelium in the intergluteal zone, and small purulent discharge over the rectal opening.
Epithelial coccygeal passage according to ICD
The International Classification of Diseases (ICD) is the basic document in medicine, used as the main statistical classification base. Under the guidance of WHO, it is reviewed once every ten years. In this system, diseases are indicated by Latin letters and numbers. This innovation was made after the adoption of the Tenth Revision (ICD-10). The epithelial coccygeal passage is present in this system along with other pathologies.
The ICD-10 classification is based on a three-digit code that encodes mortality data provided by various countries to WHO. In our country, its use is mandatory during forensic psychiatric examinations and in clinical psychiatry.
ICD-10 code for the epithelial coccygeal passage - L05.0 in case of an abscess. Pathology belongs to the XII class "Diseases of the skin and subcutaneous tissue." In the absence of an abscess, the ICD code for the epithelial coccygeal passage is L05.9.
Classification
There is no generally accepted division of the disease according to any criteria today. The same processes lead to different operationalinterventions. This contributes to confusion in assessing the results of treatment and leads to not always justified actions of the doctor.
Currently, the classification of the epithelial coccygeal tract, proposed in 1988 by the State Research Center of Coloproctology, is considered the most complete. According to her, the disease is divided into the following forms:
- uncomplicated;
- acute inflammation characterized by infiltration and abscesses;
- chronic inflammation, in which the same phenomena are noted, mostly recurrent, and purulent fistula;
- remission.
Thus, this classification is not related to the epitheliococcygeal tract code.
Diagnosis
In most cases, the diagnosis of "epithelial coccygeal duct" is based on:
- gathering anamnesis;
- examining a patient;
- digital examination of the rectum.
In the first case, the factors of the onset of the disease, dysfunctions of the pelvic organs, which have a history of trauma to the sacrococcygeal region, the duration and nature of complaints are identified.
Examination of the patient is performed when he is in the knee-elbow position or lying on his stomach. The doctor evaluates the condition of the epithelium of the buttocks, the sacrococcygeal region, the perianal zone, the number and location of the holes characteristic of this pathology. During the examination of the anus and perineum, concomitant ailments are revealed: rectal prolapse, fistulas, hemorrhoids, anal fissure. Duringpalpation determines whether there is cicatricial and inflammatory processes in the sacrococcygeal zone.
Digital examination of the rectum evaluates the condition of the last area, as well as the location of the Morganian crypts.
Also, the doctor may prescribe additional tests:
- Sigmoidoscopy. In this case, the mucosa of the distal sigmoid and rectum is examined. In the first, the presence of inflammatory dynamics is noted. The nature of the vascular pattern is also assessed.
- Fistulography. It is carried out in difficult cases for differential diagnosis.
- Ultrasound of the sacrococcygeal zone. With the help of this study, the depth of the location of the focus from the integument of the skin, the degree of involvement in inflammation of the subcutaneous fatty tissue, surrounding tissues, the presence of additional passages, the structure and size of the pathology, its localization.
Clinical picture
Depending on it, a complicated purulent process and an uncomplicated epithelial coccygeal passage are distinguished.
In the first case, the pathology can be in acute or chronic form, as well as remission. If the waste products are delayed in the course, then the appearance of a painless infiltrate with clear contours is noted, which interferes with movement.
If it becomes infected, acute inflammation develops, accompanied by pain syndromes. The skin over the infiltrate becomes hyperemic and edematous. There is an increase in body temperature.
In chronic inflammatory processes, the general condition of a personremains stable, there is a slight purulent discharge from the openings of the passage, no hyperemia and edema are observed. Around the secondary of them, cicatricial tissue dynamics occurs. Some of the secondary holes heal, others continue to function. If remission is observed for a long time interval, they close with scars. Primary holes do not produce any selection when pressed on the stroke.
An abscess in the coccyx area can be opened by doctors or by itself. At the same time, the closure of the wound is noted without the formation of a fistula, pain syndromes disappear, external signs of the inflammatory process disappear. However, the focus of chronic infection goes into a dormant state and can exacerbate with the formation of recurrent abscesses, fistulas and phlegmon. They can come after a few months, and after a certain number of years.
Between them, the patient continues to be disturbed by discharge from the primary holes, discomfort or dull pain in the coccyx area, which usually occurs when sitting.
Photos of the epithelial coccygeal passage are not very attractive.
Conservative treatment
It is mainly used in chronic forms. In addition, it is used to prepare for surgery for epithelial coccygeal passage.
Therapy includes the following activities:
- diathermy and cryotherapy - the destruction of the fistulous epithelium by exposure to high or low temperatures, respectively;
- hyperbaric oxygenation - oxygen is supplied to the tissue under pressure, which helps to restore the affectedplots;
- weekly shave covering the intergluteal crease from the waist to the anal canal, 2 cm wide;
- hygiene, including frequent washing and drying of the intergluteal zone.
Surgery
The main method of treatment of epithelial coccygeal passage is the operation. In the immediate order it is carried out with an acute form of inflammation. If there is a chronic form, then the operation for the epithelial coccygeal course is carried out as planned.
The type of surgery is determined by the following factors:
- prevalence of the process;
- his stage;
- clinical picture.
During its execution, the main source of inflammation is removed - a passage with primary and secondary holes, the surrounding tissues changed as a result of pathology.
For any type of operation, the patient is placed on his stomach, his legs are slightly spread apart to gain access to the intergluteal crease.
The following forms of surgical intervention are used today:
- sinusectomy - subcutaneous excision of the epithelial coccygeal passage;
- open operations;
- excision with suturing the wound tightly;
- marsupialization - opening a cyst with removal of its contents and sewing into the outer wound of the edges of its wall;
- excision with repositioned flaps.
Excision with closed wound closure
It is used for uncomplicatedmoves. Methylene blue is injected into the primary holes to detect leaks and branches. The passages are excised with two excising incisions in a single block with the epithelium of the intergluteal fold with subcutaneous tissue, which contains the passages, with all available holes, to the sacrococcygeal fascia.
The following contraindications are typical for this type of operation:
- presence of infiltrates in the intergluteal zone;
- previously undergone operations with cicatricial deformity of this area.
Positive results after surgery are observed in 58-88% of cases. However, complications can reach 31%.
Marsupialization
It is performed in acute form in the stage of infiltration.
The initial excision is performed in the same way as previously described. In the future, it is carried out along the back wall of the passage, affecting the upper sections of the side walls. Then the epithelial edges of the incision are sutured in a checkerboard pattern to the surface of the coccyx and sacrum. Stitches are removed after 10-12 days.
More than 93% of patients are positive.
Open Operations
They are performed with acute inflammation in the abscess stage. Such operations are performed in two stages. At the first stage, the abscess cavity is punctured at the point of greatest fluctuation, the contents are pumped out with a syringe. It is opened by making a longitudinal incision.
After the removal of acute inflammation at the second stage, a gentle excision of the branches and the coccygeal passage itself, the surrounding tissue, is carried out, the wound is opened.
Positiveresults, including satisfactory, are observed in 79-87% of patients.
Excision with wound repair
It is carried out with recurrent pathologies or advanced forms, in which there are many fistulous streaks on the buttocks.
When using this method of surgical intervention, the passages are excised with branches, external fistulous openings, surrounding tissues, skin, infiltrates and cavities up to the sacral fascia in a single block.
Cutting out skin-fat flaps is performed separately, mainly at an angle of 60 degrees to the main wound defect, since it provides them with good blood supply with good mobility. The flaps are made to the maximum thickness in order to contain all the subcutaneous tissue.
More than 84% of patients have positive results.
Sinusectomy
It is carried out with remission of the inflammatory process, its chronic form in the stage of purulent fistula and uncomplicated course.
It is excised from primary to secondary holes under the skin. Carry out staining with methylene blue. After excision, a bellied probe is passed through the holes and a passage is excised on it using electrocoagulation. The wounds that form are not sutured.
Positive result delayed, observed in 93% of cases.
Further management
After surgery for the epithelial coccygeal course, patients undergo:
- Daily wound dressings using the following drugs: Povidone Iodine, Iodopyrone, Betadine, Hydrogen Peroxide, Dioxidine, Chlorhexidine.
- Daily UV exposure and microwave therapy.
- Use of ointments for faster tissue repair ("Methyluracil") with anti-inflammatory and antimicrobial properties ("Fuzimet", "Levosin", "Levomekol").
Complications of late treatment
In this case, the inflammatory process can cover the entire sacrococcygeal zone, which can lead to the formation of multiple secondary fistulas located in the perineum, inguinal folds, and scrotum. Pyoderma and fungal diseases can be added to them.
Will require long-term outpatient treatment, excision of a larger surface of the skin, surgery in several stages.
Forecast and prevention
Full recovery can occur at any stage of treatment.
For the prevention of acute inflammation, general strengthening measures should be taken:
- treat concomitant proctological ailments in time;
- eliminate constipation and diarrhea;
- treat atherosclerosis and diabetes;
- prevent or fight infections in time;
- strengthen immunity;
- observe personal hygiene, especially in the intergluteal area.
In closing
Epithelial coccygeal passage is a birth defectsoft tissues in the area where the tissues of the sacrococcygeal region are located. Mostly it manifests itself in young people 15-30 years of age. Treatment is mainly surgical, radical. In normal cases, surgery is easily tolerated by patients. The prognosis of the disease is favorable. With untimely treatment, secondary fistulas may develop at a sufficiently large distance from the intergluteal space.
