From the Guidelines
Emergency room treatment for a pilonidal cyst should involve incision and drainage if the cyst is infected and causing severe pain, as recommended by the Infectious Diseases Society of America in their 2014 update 1. The procedure typically begins with cleaning the area, followed by local anesthesia injection. The doctor will make a small incision to drain pus and debris, then clean the cavity and possibly pack it with gauze. Some key points to consider in the treatment of pilonidal cysts include:
- Pain medication such as ibuprofen (400-800mg every 6-8 hours) or acetaminophen (500-1000mg every 6 hours) will be prescribed for post-procedure discomfort.
- Antibiotics like clindamycin (300-450mg four times daily for 7-10 days) may be given if there's significant infection, although the benefits of adjunctive antimicrobial therapy in preventing recurrences are unknown 1.
- After treatment, it's essential to keep the area clean by showering daily, changing dressings as instructed, and possibly removing and replacing packing material if used.
- Sitting may be uncomfortable for several days, and follow-up with a surgeon is crucial as recurrence is common, and definitive surgical treatment might be recommended. The goal of emergency room treatment is to address the acute problem, but complete resolution often requires follow-up care to prevent recurrence, especially since pilonidal cysts can be caused by local factors such as foreign material or hidradenitis suppurativa, eradication of which can be curative 1.
From the Research
Pilonidal Cyst Emergency Room Treatment
- Pilonidal disease can range from a routine cyst with abscess to extensive chronic infection and sinus formation, and can be associated with significant morbidity and prolonged wound healing after definitive surgery 2.
- In the emergency room, pilonidal disease may present as an acute abscess at the gluteal cleft that is warm and tender with purulent drainage 3.
- Treatment of pilonidal cysts in the emergency room may involve incision and drainage of the abscess, as well as antibiotic therapy.
- In some cases, pilonidal cysts can become complicated by severe infections, such as pyomyositis, which can be caused by methicillin-sensitive Staphylococcus aureus (MSSA) 4.
- Aggressive antibiotic and surgical treatment, with additional application of immunoglobulins, may be recommended for treatment of complicated pilonidal cysts 4.
- Clinicians should be vigilant in assessments, treatments, therapies, referrals, and patient education, as pilonidal disease can have a significant impact on an individual's life, work, and health 3.