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Epithelial coccygeal course
The epithelial coccygeal course (the disease also has other names — an epithelial coccygeal cyst, a tailbone cyst, coccygeal fistula, a pilonidalny sine) is a defect of inborn character. It is shown in soft tissues of a sacrococcygeal zone. This illness generally brings discomfort to people of young age: patients of an age group from 15 to 30 years most often see doctors. It is often noted at male patients.
The person having this illness strictly in the middle of the buttock line approximately for 4–7 cm from edge of an anus has an opening. Sometimes it happens almost imperceptible, in the form of a point, but in certain cases such opening can be rather wide and to look as well noticeable funnel. This opening also is the beginning of the coccygeal course. The course blindly terminates in hypodermic cellulose, it is not connected with a sacrum and a tailbone. Actually such opening is entrance gate for an infection.
Often it happens that the person lives many years with this disease and does not assume about its existence. Yet the inflammation and all its effects does not develop, periodic small allocations can not concern the patient.
Explicit symptoms of a disease are shown at the person after the infection gets inside through an opening. It often occurs as an effect of an injury of a tailbone, strong overcooling, the postponed flu. Sometimes it occurs without the visible reasons. Owing to these factors expansion of the epithelial coccygeal course is noted, its wall can collapse, inflammatory process in the field of a sacrum and a tailbone gradually develops. The inflammation joins also a fatty tissue.
At development of an inflammation of people notes manifestation of pain, in a tailbone zone it shows a swelling, reddening in the field of an opening which sometimes extends from it aside. The inflammation, as a rule, forces the person to ask for medical assistance. At such manifestations the acute form of a disease is diagnosed. In the presence of abscess in the area where there are coccygeal courses, it can independently be opened. If during this period treatment of the epithelial coccygeal course practices, then such operation is performed by the specialist. After that pain abates, the patient feels much better. However on that place later where the opening was opened, secondary fistula in which periodic suppuration can be observed forms. If at the patient fistula is formed, then periodically he is disturbed by pain, besides, the allocations complicating daily hygiene constantly are observed. Besides, on site inflammations the cyst, besides perhaps ozlokachestvleny tumors can develop over time. Therefore only excision of the coccygeal course by means of an operative measure finally will help to resolve a problem.
However, in certain cases after abscess of sacrococcygeal area was opened by the doctor, or it occurred independently, the wound is closed for some time completely. But nevertheless in an organism there is a center of persistent infection at the epithelial coccygeal courses. Over time it leads to a repeated exacerbation of a disease and repeated emergence of abscess. Sometimes on this place phlegmon develops. Such aggravation sometimes occurs in several months, in certain cases the period of wellbeing can last even several years. Even between aggravations of people notes existence of some symptoms: he is disturbed by dull aches which are shown from time to time. During sitting often there is a discomfort in the field of a tailbone. Sometimes there are small allocations.
Thus, being guided by a clinical picture, specialists it is accepted to distinguish the uncomplicated and complicated by purulent processes epithelial coccygeal course.
At the complicated form of an illness the acute and chronic course of an illness is noted, and also the remission periods are periodically noted.
If allocations do not come from the coccygeal course timely, then at the patient the bezboleznny infiltrate having accurate contours can be shown. The person feels it during movements, feeling discomfort. If there is an infection of the course owing to what the acute inflammation develops, then at the person body temperature can sharply increase.
If at the patient the chronic course of a disease is noted, then there are no noticeable changes in the general state. There is no hyperemia, hypostases on site of defeat, allocations are poor. On site secondary openings cicatricial changes of fabric are shown.
Closing of openings with hems is characteristic of the period of remission, when pressing on primary openings of allocations it is not observed.
If the patient a long time ignores such symptoms and persistently refuses treatment, then changes in the coccygeal course which arise under the influence of inflammatory process lead to emergence of several secondary fistulas. As a rule, such fistulas are formed far from primary place of defeat. Sometimes they arise in krestsovo-coccygeal area, can also appear on a scrotum, in inguinal folds, on a crotch. At such course of a disease it is often aggravated with a pyoderma, and also fungal infections. Such complications considerably aggravate its current. When carrying out operation by such patient excision of fabric is carried out on rather big square, and, operation sometimes cannot be carried out in one step.
As it was mentioned earlier, one more heavy complication of the coccygeal course, long time not exposed to treatment, is transition of an illness to a malignant form. Such complication happens rather seldom, but nevertheless sometimes takes place.
Process of establishment of the diagnosis does not present special difficulties for specialists. The main sign on the basis of which the diagnosis is established is characteristic localization of process. Seeing a doctor, patients, as a rule, complain of pain of different character and intensity in close proximity to a mezhjyagodichny fold, and also note existence of purulent discharges from fistulas. One more important diagnostic character – existence of fistular primary openings. Communication of fistula with a rectum in this case is not found.
In the course of survey of the place of defeat the doctor conducts manual research of a rectum, and also the proctal channel to exclude other illnesses. Through a back wall of a rectum also sacral and coccygeal vertebrae for the purpose of definition of existence or lack of changes are palpated.
During diagnosis sometimes the specialist experiences certain difficulties in attempts to distinguish the coccygeal courses and pararectal fistulas. It occurs if primary openings are located very low over an anus.
Mistakes in the course of diagnosis can arise and if purulent complications take place. In this case the doctor can suspect not only pararectal fistula, but also an acute paraproctitis, tailbone osteomyelitis. At establishment of the wrong diagnosis incorrect approach to treatment practices. Respectively, the risk of complications and transition of a disease to the started form increases.
It is also important to differentiate the epithelial coccygeal course from a cyst, pyodermas with fistulas, rectum fistula. Therefore in the course of establishment of the diagnosis obligatory researches is the rektoromanoskopiya and sounding of the coccygeal course.
Patients have to realize that in the presence of the epithelial coccygeal course only carrying out an operative measure will help to cure an illness. Therefore, treatment of this disease is carried out only by a surgical method. In the course of an operative measure the source of inflammatory process — the epithelial channel and all primary openings cleans up. Also if necessary the changed fabrics in the field of the coccygeal course, and also secondary fistulas are excised. Specialists consider a question of terms, and also of methods of surgical intervention taking into account clinical classification of a disease.
If for the person it is diagnosed uncomplicated epithelial coccygeal ho with primary openings, but without existence of an inflammation, then operation is performed in a planned order. Before operation the course is painted over through primary openings then it is excised. In this case after operation there is rather uncomprehensive wound, therefore, fabrics not strongly stretch after a tightening of seams. In this case the wound can be sewn up completely.
The patient with an acute inflammation of the coccygeal course performs operation at which the stage, and also extensiveness of an inflammation is surely considered.
At the infiltrate which is not going beyond a mezhjyagodichny fold a radical operative measure in the course of which the coccygeal course and primary openings is excised is carried out. However use of a deaf seam is not practiced in this case.
At distribution of infiltrate out of limits of a mezhjyagodichny fold a number of the conservative methods directed to infiltrate reduction is initially applied. For this purpose heat baths are daily carried out, ointments on a water-soluble basis are imposed (levomekol), physiotherapeutic treatment practices. After reduction of infiltrate radical operation is performed.
If abscess is diagnosed for the patient, then a radical operative measure is carried out at once. In the course of operation the course and walls of abscess is excised. If at the patient the extensive contaminated wound takes place, then it will heal rather long time, and after its healing there is a rough hem. To avoid it, at acute inflammatory process operation is sometimes carried out in two steps. Opening of abscess, its daily sanitation and the treatment directed to elimination of an extensive inflammation is initially made. In several days the second phase of operation is completed. Doctors do not recommend to otstrachivat radical operation for the long period as over time complications of a disease can develop.
At a chronic inflammation of the coccygeal course perform planned operation, but at the same time at the patient the exacerbation of an illness should not be observed. Operation is performed with full anesthesia to which ensuring epidural and sacral anesthesia is applied. At simple interventions the local anesthesia sometimes practices. Operation duration — of 20 minutes till 1 o'clock.
At a radical operative measure at any stage of an illness doctors give the favorable forecast. As a rule, patients undergo an operation easily, and in several weeks working ability of the patient is recovered, and the wound heals approximately in a month. The removal of sutures is made approximately for the tenth day. After operation before normalization of a condition of the patient stays in a hospital where anesthesia is provided to it. Supervision at the specialist before final recovery is important. To a full wound repair it is necessary to shave hair on edge of a wound. You should not sit, and also to lift weights before the wound completely heals.
In the first months after operation the patient is not recommended to wear narrow clothes with dense seams not to allow injuries. It is very important to follow all rules of hygiene carefully. Regular careful washing, and also daily shift of linen is necessary. It has to be from cotton fabric.