The Epitelialny coccygeal course – the congenital pathology which is characterized by defect existence (the narrow channel) in hypodermic cellulose of interbuttock area. Clinical manifestations are connected with an inflammation of the coccygeal course. There is pain in sacral and coccygeal area, allocations of an ichor or pus, reddening and consolidation of skin. Neglect of a disease brings to a long recidivous current: to an abstsedirovaniye, formation of secondary purulent fistulas, development of a piodermiya on skin of a crotch and buttocks.
Epitelialny coccygeal course
The Epitelialny coccygeal course represents congenital defect (a narrow tubular cavity) in fabrics of sacral and coccygeal area. Sometimes EKH call a dermoidny cyst of a tailbone, a pilonidalny sine, we whistle a tailbone. Primary epitelialny coccygeal course opens on skin of buttocks (in a mezhjyagodichny fold) one or several small openings, its other end terminates in hypodermic cellulose and has no message with a sacrum or a tailbone.
Periodically through dot exits of coccygeal fistula waste products of the epithelium covering it are emitted. Besides, through these openings the infection can get into fabrics. The Epitelialny coccygeal course long time is not shown clinically. Patients address the proctologist usually at EKH inflammation.
At obstruction of primary openings of the course there is a stagnation of its contents that leads to reproduction of microorganisms and a purulent inflammation. The Epitelialny course will extend, its walls are exposed to purulent fusion, and the infection leaves in surrounding hypodermic fatty cellulose. The large abscess is usually opened through integuments and the secondary opening of EKH is formed.
Causes of the epitelialny coccygeal course
The Epitelialny coccygeal course is formed in the embryonic period. In development of a fruit there is a failure and under skin in the field of a buttock fold there is a course covered inside by an epithelium. This congenital defect is quite widespread. Abroad it is quite often called a hair cyst as there is an assumption that the wrong growth of hair and their growing into skin is the reason of formation of EKH.
Classification of the epitelialny coccygeal course
Clinical classification of the epitelialny coccygeal course distinguishes its uncomplicated form (the existing course without signs of an inflammation and complaints), an acute inflammation of EKH and a chronic inflammation.
Inflammations of the coccygeal course are distinguished on stages: infiltrative (both at sharp and at a chronic inflammation an early stage of a disease before formation of an abscess) and abstsediruyushchy (in case of a chronic inflammation – a stage of recurrent abscess). At a chronic inflammation also allocate a stage of purulent fistula.
Symptoms of the epitelialny coccygeal course
In the first years of life the epitelialny coccygeal course is not shown in any way. In the period of a puberty in the course growth of hair, release of waste products of an epitelialny vystilka begins (grease, sweat glands). At the same time there can be a feeling of an itch, moknuty because of allocations from EKH. An arrangement of an exit of the epitelialny coccygeal course near a zone of back pass, the increased humidity in a mezhjyagodichny fold, vigorous activity of skin glands promote obstruction of the course, and stagnation of contents promotes development of an infection. The factors promoting inflammatory process in the coccygeal course are: the raised pilosis of a zone of primary openings, non-compliance with hygienic rules, a trauma, a raschesa.
The inflammation of EKH is characterized by pain in the field of a sacrum, sometimes to sanious or purulent separated. Often patients assume that the symptomatology is a consequence of a trauma.
Originally the acute inflammation develops, infiltrate is formed, and then - purulent abscess. If at this moment of the patient sees a doctor, necessary medical actions for removal of EKH are made, then there occurs recovery. If the address to the doctor did not follow in time, most often there is a spontaneous opening of abscess on skin. After that usually there is a pain relief, however most often the infectious center remains that leads to synchronization of an inflammation. The purulent fistula connecting an abscess cavity to skin is formed, the disease flows wavy, there is suppuration recurrence. Chronically existing inflammation gradually covers the increasing zone, organism intoxication accrues.
Diagnostics of the epitelialny coccygeal course
The Epitelialny coccygeal course is not difficult in diagnosing, for its identification there is usually enough detection of primary openings in a mezhjyagodichny fold. At the available inflammation, abscess, purulent separated make the diagnosis "the complicated epitelialny coccygeal course". At detection of this disease carrying out additional researches as measures of an exception of other possible pathologies is shown.
Carry an obligatory manual research of back pass with a palpation of a tailbone and sacral vertebras to such measures. From tool techniques appoint a rektoromanoskopiya for an exception of diseases of a rectum, and in case of not clear symptomatology – a kolonoskopiya. However, most often in view of youth of most of patients to resort to broad diagnostic actions there is no need. In rare instances need of differentiation of the epitelialny coccygeal course from other disease, makes a fistulografiya.
Differential diagnostics of the epitelialny coccygeal course is made with we whistle a rectum at a paraproktita, a coccygeal cyst, back to a meningotsela, osteomyelitis of a tailbone and sacrum, presakralny teratomy. Data for differentiation are obtained by means of survey of a mezhjyagodichny fold, a manual research of a rectum, sounding of fistula and a fistulografiya.
Rectum fistula when sounding goes not in the direction of a tailbone, and to a rectum and at a fistulografiya note its second exit in one of morganiyevy crypts. The Epidermoidny coccygeal cyst is usually painless and is probed as mobile consolidation under skin, but at suppuration can imitate clinic of the epitelialny course. However at survey primary openings are not found.
Back to a meningotsela it is palpated as oval formation of a dense and elastic consistence, almost motionless under skin, painless. Also has no primary openings. In the anamnesis functional pathologies of bodies of a small pelvis are noted, it is frequent – enuresis. Suspicion on the meningotsel is the indication to carrying out a X-ray analysis of a sacrum and consultation of the neurosurgeon.
The embryonic course opening on skin near back pass can be a sign of a presakralny teratoma. Sometimes the opening is very similar to the epitelialny coccygeal course, besides teratoma can provoke purulent inflammations in a sacral and coccygeal zone. Teratoma comes to light at a manual research between a back pryamokishechny wall and a sacrum, is palpated as a tumor of a dense consistence. Ultrasonography and a fistulografiya can be additional techniques of differentiation.
Detection of osteomyelitis of a sacrum and tailbone is also made by means of a palpation of vertebras through a back wall of a rectum. At the same time pathological mobility of bones, a vybukhaniye, a pasty consistence can be noted. Suspicion of existence of osteomyelitis is the indication to carrying out a X-ray analysis of a basin.
Treatment of the epitelialny coccygeal course
The Epitelialny coccygeal course is treated only in the surgical way. Surgery means radical removal of the pathological channel with primary openings. In case of the complicated epitelialny course also pathologically changed surrounding fabrics, purulent fistulas are excised. Postoperative treatment includes a course of antibacterial therapy (antibiotics of a broad spectrum of activity within 5-7 days), and also the physiotherapeutic techniques promoting bystry healing of a wound. In quality prevention of a measure of a postoperative recurrence make removal of hair around a wound, and then and around a hem.
The postoperative retsidivirovaniye of an inflammation can demonstrate insufficiently full removal of the infectious centers, purulent zatek, primary openings, fistulas. Despite a simple technique of carrying out operation, note higher percent of a postoperative recurrence at treatment in surgical offices of a wide profile unlike specialized offices of a proktologiya. The patients who underwent treatment in non-core office risk to handle a disease recurrence more than ten times more often.
In view of bigger practical experience, knowledge of nuances of an anatomic structure of a pararectal zone, specialists of koloproktologichesky offices are more preferable to the address concerning the complicated epitelialny coccygeal course.
Possible complications at refusal of radical treatment
Operation on removal of the epitelialny coccygeal course is not emergency and sick can postpone it or at all refuse radical treatment, being limited to drainage of purulent cavities. However the long current of a purulent inflammation promotes its distribution on surrounding cellulose, formation of new abscesses, the svishchevy courses of complex structure with exits to crotch skin, in inguinal folds. At the same time the piodermiya often develops, actinomycosis, considerably worsening a condition of the patient joins. Treatment at the same time considerably is at a loss and demands more time, surgical intervention is made in bigger volume, the postoperative period proceeds heavier and the probability of a retsidivirovaniye is high.
The forecast at the epitelialny coccygeal course
During full-scale radical removal of the epitelialny course and all struck fabrics the forecast is favorable, there occurs recovery. After carrying out operation patients are under observation of the expert before full healing of an operational wound.
As preventive measures, hair at the edges of a wound shave in process of growth, wear linen free of the natural breathing fabrics. It is necessary to observe carefully hygienic recommendations, to carry out a regular toilet of a perianalny zone, mezhjyagodichny space.