P. Emengo1, C. Abrajano1, B. Chiu1 1Stanford University, Pediatric Surgery, Palo Alto, CA, USA
Introduction:
Symptoms at the gluteal cleft are often due to pilonidal disease, but other diseases may also present similarly. Management of these diseases are different and erroneous diagnosis and subsequent wrong treatment can lead to significant morbidity. We aim to create a diagnostic algorithm that can differentiate the various diagnoses.
Methods:
We performed a retrospective review of all patients who presented to our Pilonidal Clinic from 2019-2023. Patients with gluteal cleft symptoms that are not due to pilonidal disease or have another diagnosis in addition to pilonidal disease are identified. Patient demographics, tests used to confirm the diagnoses, and treatment outcome were recorded.
Results:
320 patient charts were reviewed, and 20 patients with another non-pilonidal disease diagnosis were selected. 4 patients (all females) had neurological diseases: Schwannoma, central disc protrusion, arachnoid cyst, and Tarlov cyst; 7 patients (all males) had dermatological diseases: folliculitis and moisture-associated skin damage; 4 patients (3 males, 1 female) were thought to have inflammatory bowel disease but did not; 4 patients (all males) had sacral dimple; 1 patient (female) had a sacral pressure ulcer. Clinical diagnostic decisions were based on the presence and location of an open wound, history of immobility, presence of gluteal cleft swelling or pit, clinical symptoms of pain or erythema, and other similar lesions on the body. These characteristics were utilized to differentiate the diagnoses and construct a diagnostic algorithm (Fig 1).
Conclusion:
We developed the first diagnostic algorithm for differentiation of gluteal cleft pathologies. The algorithm provides guidance for clinicians to make the correct diagnosis and avoid unnecessary treatment and morbidity.
