Chronic Pilonidal Cyst Management in Young Adult Male

Case at a Glance

A 20-year-old male presents with a 5-year history of pilonidal cyst with multiple sinus tracts, managed conservatively with topical antiseptics, showing partial improvement but experiencing recurrent episodes of infection.

Patient's Story

The patient discovered his pilonidal cyst approximately 3 years ago, though clinical assessment suggested the condition had been present for at least 5 years total. At initial presentation, he had four distinct sinus openings with active purulent discharge and bleeding. Over the past 3 years, he has maintained strict hygiene protocols and daily application of povidone-iodine (Betadine) antiseptic solution. He reports significant improvement with closure of the largest sinus tract and substantial reduction in pain levels. However, he continues to experience cyclical flare-ups every 3-4 months, lasting 4-5 days, characterized by mild pain and minimal serous discharge.

Initial Assessment

Physical examination revealed multiple pilonidal sinus tracts in the sacrococcygeal region with evidence of chronic inflammation. Active purulent drainage and bleeding were noted from four distinct openings. The patient demonstrated good understanding of hygiene maintenance and had been self-managing with topical antiseptics.

The Diagnostic Journey

The patient consulted with multiple physicians, including two surgeons, regarding treatment options. Conservative management with antiseptic care was initially pursued given the patient's young age and preference to avoid surgery. Clinical monitoring showed partial response with closure of the primary sinus tract.

Final Diagnosis

Chronic pilonidal disease with multiple sinus tracts, partially responsive to conservative management

Treatment Plan

Surgical consultation recommended complete excision of the cyst and all associated sinus tracts as definitive treatment. Conservative management options were discussed, including continued antiseptic care and hygiene maintenance. The patient expressed significant anxiety regarding surgical intervention, particularly concerning post-operative positioning requirements and recovery period.

Outcome and Follow-up

Partial clinical improvement achieved with conservative management, including closure of primary sinus tract and reduced symptom severity. Patient continues to experience periodic flare-ups but with decreased intensity. Ongoing discussion regarding surgical versus conservative management based on patient preferences and quality of life considerations.