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Sacral Pain

Rajesh Geria, MD, FACEP, RDMS, Mizuho Morrison, DO, and Mike Weinstock, MD
00:00
19:11

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Miz and Mike talk to Dr.Rajesh Geria to discuss a case of a young woman with sacral pain. After multiple misdiagnosis, the pt was ultimately diagnosed with a pilonidal cyst. They discuss the importance of a focused exam, particularly looking at the area of concern. Also management of this diagnosis is discussed.

Pearls:

  • Patients with pilonidal cysts should be referred to a general surgeon for definitive management and removal.

 

Differential Dx For Sacral Pain

  • Musculoskeletal sprain/strain

  • Cauda equina

  • Epidural abscess

  • Fracture

  • Constipation

  • Menses

  • Herpes zoster

  • Pilonidal cyst

 

Background - Infected Pilonidal Cysts

  • A pilonidal cyst is essentially a sac filled with debris and hair trapped under the skin of the sacral region.

  • It is more common in men, young people, patients with heavy hair growth and patients with a family history of pilonidal cysts.

  • It can be secondary to strep and staph in addition to anaerobes.

 

Management - Infected Pilonidal Cysts

  • Like all abscesses, the mainstay in management is incision and drainage. Needle aspiration is not sufficient to adequately drain these abscesses.

  • Infected pilonidal cysts can be particularly foul smelling so use suction to keep the odor to a minimum.

  • Patients should be referred to a general surgeon who will remove the cyst as an outpatient to prevent occurence.

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No...You Aren't Gonna Die! Full episode audio for MD edition 226:23 min - 106 MB - M4AUC RAP February 2019 Written Summary 353 KB - PDF

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