The EPITHELIAL COCCYGEAL COURSE (Greek epi-on, atop + thele of pacifiers; synonym: a dermoid cyst of a tailbone, epithelial fistula of a tailbone, a dermoid fistula, a piloni-dalny cyst, a pilonidalny sine, a sequestral dermoid, an ectodermal sacrococcygeal sine, a hair cyst, epithelial immersions of sacrococcygeal area) — the pathological channel covered by a multilayer flat epithelium, opening most often in a mezhjyagodichny fold of skin at a tailbone.
Data on frequency E. to. x. are various. According to C.3. Oganesyan (1970), it occurs approximately at 0,2% of adults, at men considerably more often than at women.
The etiology is finally not found out. Supporters of the most widespread theory inborn E. to. x. consider that it develops from elements of a rudiment of a brain tube or is result of ectodermal invagination. The opinion is expressed that existence
E. to. x. it is connected with an incomplete reduction of elements of a tail. Supporters of less popular theory acquired E. to. x. explain its emergence with a drift in hypodermic cellulose of epithelial cells, the hair which are implemented into it that is promoted by friction and perspiration of skin, non-compliance a gigabyte. rules of care of it, repeated small injuries of this area. Some researchers assume that the epithelial coccygeal course can be both inborn, and acquired.
AA. to. x. opens on skin in the field of a tailbone one or several pinholes (primary openings). At an obliteration of openings the cyst is formed (see). In 25 — 50% of cases inside E. to. x. or the cyst which arose on its place hair contain, to-rye can be implemented into sidewalls and form the additional courses. AA. to. x. from within it is covered with a multilayer flat keratosic epithelium, and in its gleam, in addition to hair, the desquamated epithelium and leukocytes are found. In the fabrics surrounding E. to. x., the phenomena hron are noted. inflammatory process, to-ry can become aggravated and be complicated by development of abscess (see) or phlegmons (see). At an empyema of cyst pus can break outside with formation of one or several secondary purulent fistulas (see).
Patients with uncomplicated E. to. x. complain of an itch, maceration of skin, sometimes dull aches in the field of a tailbone. At survey on skin in the field of a tailbone, is more often on the centerline, find one or several openings, from to-rykh hair will quite often stand, and during the pressing muddy liquid is emitted. In the presence of a cyst in the thickness of hypodermic cellulose the oval or round formation of an elastic consistence soldered to surrounding fabrics is defined. At the complicated current E. to. x. (i.e. an aggravation of inflammatory process) there are enough megalgias; at a palpation painful infiltrate is defined, skin over the Crimea is hyperemic. The indisposition is noted, body temperature increases. At formation of abscess fluctuation appears (see Zybleniye). Outside openings of the secondary fistulas formed as a result of spontaneous opening of abscess or phlegmon, and also the recuring fistulas can be located away from the centerline, near an anus. In some cases purulent fistula can pass on a circle of an anus and open on a crotch.
The diagnosis is made on the basis by a wedge, pictures and data of survey, in doubtful cases resort to a fis-tulografiya.
Treatment operational. Before operation it is reasonable to make a fistulog-raffia (see) for specification of an arrangement E. to. x. and detection of the additional courses. Before operation in E. to. x. enter 1% solution methylene blue (see) for coloring of its walls that facilitates radical excision of all branchings. Operation at uncomplicated E. to. x. make more often under a local anesthesia (see Anesthesia local), and at recurrent and complicated — under anesthetic (see). At uncomplicated E. to. x. (or a cyst) operation consists in excision of its walls with a surrounding fatty tissue to the fascia covering a tailbone. After that put the vertical P-shaped or 8-shaped adapting stitches (see Seams surgical) with obligatory capture of the fascia covering a tailbone. Stitches need to be put so that walls of a wound densely adjoined with each other. At operation for a recurrence E. to. x. with existence of secondary purulent fistula after broad excision of the purulent course of edge of skin hem to the fascia covering a tailbone thereby reducing the sizes of a wound and reducing terms of its healing. Multiple purulent fistulas exsect, and the wound heals second intention. The suppurated epithelial coccygeal cyst can also be excised considerably; at the same time apply antibacterial therapy both during operation, and in the postoperative period.
At E. to. x., complicated by abscess or phlegmon, open only a suppurative focus, and make radical operation after subsiding of an acute inflammation. Recently successfully apply a method of flowing and aspiration drainage of the wound which is sewn up after radical excision of a suppurative focus.
Forecast favorable. After not radical operation E. to. x. quite often recurs.
Bibliography: Aminev A. M. Guide to a proctology, t. 1, page 307, Kuibyshev, 1965; Outside and internal fistulas in surgical clinic, under red «
E. N. Vantsyana, page 239, M., 1982; Oganesyan of Page 3. Epithelial courses and cysts of coccygeal area, Yerevan, 1970; Rivkin V. JI. and Alexandrov V. B. Purulent fistulas of sacrococcygeal area, M., 1972; Ry
zhy A. N. Hirurgiya of a rectum, page 190, M., 1956; it, the Atlas of operations on direct and thick guts, page 106, M., 1968; Strelnikov B. E.
Epithelial cysts of sacrococcygeal area, M., 1962; Fedo
ditch V. D. and Dultsev of Yu. V. Proktologiya, page 114, M., 1984.
T. P. Makarenko, A. V. Bogdanov.