Pilonidal Abcess Excision

One of my earlier and most impressive experiences as a new nurse was when a man came into the ER complaining of a boil on his backside. I got him in a gown in preparation for the doctor’s exam. He was obviously in tremendous pain as he paced the room.

I came with the doctor knowing I’d be needed to assist. Upon exam, the doctor lost his usual aplomb and exclaimed “$?:@!: Damn! Your ass is all swole up!”

At that, I had to see. The poor man had a golf-ball sized abscess at the base of his spine between his buttocks. It was a brilliant reddish purple and so pressured it seemed to be pulsatile.

Anticipating possible contamination, the doctor and I garbed in protective gear including full facemasks and visors. The doctor had the poor man lie on his belly with his buttocks hiked up in the air. If that hadn’t been humiliating enough, he took four inch wide elastic tape and stretched the poor man’s buttocks as wide as he could.

After a good scrub, the doctor scrubbed the abscess gently. The abscess was like a volcano ready to blow. The instant the scalpel touched the bulge, it blew a huge lump of pus on the wall over the doctor’s head. As the doctor continued to compress the abscess, copious amounts of blood and pus exited. Finally. All that remained was a gaping hole that the doctor packed with iodine gauze. The poor man got an antibiotic shot. a prescription. And instructions to return for follow up care the next day. That room was so contaminated we had to shut it down till housekeeping could do a complete clean.

I wouldn’t have wanted to be that poor man that day!

20 thoughts on “Pilonidal Abcess Excision

  1. I had a similar experience (no, not me) and not on the butt and not a person. My cat developed an abscess under his ear. Because of the fur you couldn’t see it but he was unhappy. I checked it out and it burst sending goo everywhere. I still have stains on a chair. He had several over a couple weeks. We (meaning the vet) finally figured out that he has a bad yeast infection in his ear and he was scratching it so hard that he got infected wounds that healed over and developed into boils. The pus really smelled too. Yuck!

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