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Avoid emergency surgery

coccygeal abscess

Ultrasound-guided puncture instead of radical surgery

What to do if you have a coccyx abscess?

Is the final exam coming up and you are not yet prepared? Has the important presentation for your boss not yet been completed? Have you already covered hundreds of kilometers on the freeway or have you just come from a long-haul flight and

Can you hardly sit up because of the pain?

These circumstances could indicate an acute Pilonidal Sinus, known as a pilonidal abscess. The pain can become so extreme overnight that any activity becomes agony.

If you experience pain in the coccyx area, you should always consider a coccyx abscess, also known colloquially as a boil or carbuncle. An inflamed Pilonidal Sinus often shows symptoms suddenly and unexpectedly. To avoid misdiagnoses such as coccyx contusions, periostitis or overuse pain, it is advisable to consult a specialist directly.

Man grabbing his painful coccyx
Severe pain in the coccyx indicates a pilonidal abscess
Ultrasound image coccyx abscess
Coccyx abscess. Only minor swelling. Pain since 2 days.

In the early stages or with mild irritation, the inflammation can sometimes calm down without surgery. Supportive treatment with cooling, anti-inflammatory drugs such as ibuprofen and traction ointments can promote the healing process.

If the inflammation is more diffuse in the tissue rather than an encapsulated collection of pus, antibiotics can be used. antibiotics can be helpful.

If the abscess bursts open on its own in the best case scenario, the pain will subside noticeably within one to two days. Even if the discharge of blood and pus is unsettling, smells unpleasant and looks unattractive, it does not pose any danger. A burst coccyx abscess eases the acute situation considerably. The fear that an abscess could burst inwards is unfounded.

Important for pilonidal abscess

Family doctor, specialist or hospital?

Which doctor helps in an emergency?

Despite understandable fears, opening the abscess is the quickest way to freedom from pain. Which doctor should you go to? If you don't live too far away, simply send us a short e-mail to info@darmsprechstunde.de, including a photo of the affected area, and come and see us directly (Mon.-Fri. 8 a.m. - 5 p.m.).

Otherwise, your family doctor, a specialist surgeon or the emergency room at the local hospital can help you. But be careful - it is often recommended to remove the entire inflammatory process in a major operation.

We and the current guideline Sinus pilonidalis (AWMF 2020) see it differently - they only recommend relieving the abscess with a small (!) incision and operating on the fistula once the inflammation has subsided. Our minimally invasive techniques such as pit picking, laser treatment and/or sinusectomy are then almost always possible.

Two small interventions are therefore better than one large one to solve the problem effectively and gently.

Coccyx abscess surgery - emergency treatment

"Ubi pus, ibi evacua." - This Latin saying "Where there is pus, drain it" is familiar to every doctor and describes a simple and effective therapeutic principle. The practical implementation, however, especially in the case of coccyx abscesses, often causes difficulties for the doctor and unnecessary pain for the patient. We describe our technique here. 

Can I open the abscess myself?

We strongly advise against trying to do this yourself. The instructions are intended for appropriately equipped doctors in practice or hospital outpatient departments.

Attempts to squeeze the coccyx abscess are also not promising and sometimes worsen the pain and inflammation.

Painful swelling of the coccyx
Required Instruments:
  • Experience
  • Diagnostic ultrasound unit Linear transducer 7.5 or 10 MHz
  • Fine, surgical forceps, e.g. Adson
  • Fine, pointed dissecting scissors, e.g. Supercut Iris scissors 11.5 cm
Consumables:
Disposable perforated cloth
Sterile ES Compresses 10 x 10
Sterile gloves
Local anaesthetic, e.g. Prilocaine 0.5% solution for injection
2 ml disposable syringe, e.g. B|Braun Injekt® Luer Solo
Dermatological biopsy punch, e.g. Stiefel™ Biopsy Punch 5 mm
Fine, short injection cannula e.g. BD Microlance™ 30G x ½ (0.3 x 13 mm)

1. education and reassurance of the patient

We inform the patient in detail about the benign nature of their condition and the successful treatment method using a two-stage procedure. This initially involves abscess drainage followed by minimally invasive surgery on the Pilonidal Sinus in the second stage. We discuss any fears openly and comprehensively. 

You do not normally need to worry about blood poisoning, bone involvement or a connection to the intestines.

Thumbs up we help with pilonidal abscesses

2. identification of the optimal puncture site

When locating the apex of the abscess cavity, the first step is to palpate and measure the thickness of the skin over the abscess. It is important that the skin thickness for using the biopsy punch is a maximum of 5 mm. The optimal puncture site can often be localized by means of a "soft dent". In the case of a deep abscess, it is recommended to perform the cleavage under general anesthesia.

Coccyx abscess ultrasound for How To

3. injection of local anesthesia

After the intradermal infiltration of a 1.5 cm area of skin at the puncture site, we take a brief moment to check the effectiveness. We do not recommend the use of cold spray for pain relief as it is not particularly effective and the CFCs it contains are harmful to the environment.

Splitting pilonidal abscess under local anesthesia

4. opening the abscess cavity

We make a 5 mm opening with a biopsy punch and remove the skin cylinder with tweezers. If necessary, we open the abscess capsule with fine scissors. If done correctly, plenty of pus will now drain out. The round opening is large enough to prevent re-adhesion, but at the same time small enough for the patient to cope well.

Biopsy punch for puncture of coccyx abscess

Five. Stop!

The acute treatment is now complete. The remaining secretions will empty themselves. We apply a thick absorbent dressing. If there is a pronounced phlegmonous reaction in the area surrounding the abscess, an antibiotic may be prescribed. No tamponade is used and no sharp spoons are used.

Opening of coccyx abscess with 5 mm biopsy punch

We inform the patient that the risk of further abscesses recurring is very high if the second treatment step is not carried out. We offer a follow-up appointment on the following day if the inflammation has not subsided sufficiently. If you wait too long, there is a risk that the abscess will return. On the other hand, the procedure is technically demanding if it is performed too early. We therefore prefer a time interval of at least one week and a maximum of three weeks.

Important appointment to remove coccyx fistula

DR. BERNHARD HOFER & FLORIAN LIEBL

Specialists in Visceral Surgery and Proctology - PartG mbB

Brienner Str. 13, D-80333 Munich

© 2023 Proctology Practice Munich