Pilonidal cyst – assessment and referral

Symptoms

• Pain and swelling in the cleft above the tailbone, particularly when sitting.
• Recurrent abscesses or pus discharge from small openings in the midline.
• Visible redness and swelling with an acute abscess.
• Possible fever and feeling generally unwell.

Assessment and referral

Assessment is based on a clinical examination. When planned surgery is needed, we refer to an appropriate surgical department in your region. Options depend on the nature of the disease, current referral practice and the patient-choice rules that apply to your course of care.

Acute abscess

Rapidly increasing swelling, redness, pain, fever or feeling generally unwell needs same-day assessment. A mature abscess must be assessed for drainage. Antibiotics alone are often insufficient, and the need for antibiotics in addition to drainage is assessed individually. Call the clinic during phone hours. If possible, we offer an urgent consultation and opening of the abscess (incision) the same day. If we cannot, or the clinic is closed, contact your own GP during GP opening hours. Outside GP opening hours, call 1813 in the Capital Region or the regional out-of-hours service elsewhere. Call 112 if you are severely unwell or your condition is life-threatening. Do not squeeze or cut the area yourself.

Choice of surgical technique

For planned surgery, the technique is chosen individually according to the extent of disease, previous surgery and your preferences. International guidelines generally advise against direct midline closure when the wound is closed.

Sources

• Pilonidal cyst, Lægehåndbogen at sundhed.dk.
• European Society of Coloproctology guideline for pilonidal disease (2024).
• American Society of Colon and Rectal Surgeons guideline for pilonidal disease (2019).