Friday, February 16, 2007

Fountain of Pus

Some docs just dig pus. I am one of them. Tonight though, I nearly vomited while doing an I & D (incision and drainage) of a pilonidal cyst. Click the above title to learn about pilonidal cysts.

So a gentleman comes into the ED complaining of terrible pain over his "tailbone", worsening for a few days, and has an abscess just over the coccyx. We see these all the time and most ED docs will drain them and pack them and refer the patient later for definitive surgical treatment. But this one was HUGE I tell you! 4x4 inches, tender, and just begging to be opened and drained.

This guy had a cyst I&D'ed previously so he knew what he was in for and he was a great about the whole thing. I felt sorry for the patient in the next bed as they were privy to our whole conversation and heard me describe the procedure in detail and warn of the fact that when I opened the abscess that the smell would be horrible. I don't think they threw up.

I gave the guy a couple of percocet prior to numbing the area up with lidocaine and then I gloved, gowned, and put on a face shield. I was honestly worried that with the tension this thing was under that I would be covered in pus with the slightest puncture.

There's something so satisfying to me about getting pus out of the body but this was ridiculous. It took a very deep incision to puncture this cyst but when I did the game was ON! I mean pus down the guys butt crack, pus on the drapes, green and black gooey stuff that smelled worse than anything I've smelled ever in my life (except other anaerobic abscesses). Nurses came in from the hall to investigate the source of the smell and peaked in to see the spectacle of me probing this cyst with hemostats and expressing more and more pus.

I packed the thing with a whole canister of iodoform gauze and went through 4 boats of 4x4 gauze. I think I got 12 oz of pus out of this thing honestly. The patient was very thankful and left feeling much better. The smell still lingered four hours later when I left. Now that's some old fashioned down and dirty medicine right there! Medieval barber-like.


  1. ewww. Those are the worst smelling things ever. The only time I have ever gotten sick on the job, granted I was in early pregnancy at the time. Satisfying though, you take a patient who is in terrible pain and make it almost instantly better.

  2. You dawg-gone right it is one way to make a patient better IMMEDIATELY!

    I had one of those buggers several years ago. I was scared to death to go to the doctor.

    Finally when it was so big you could see the outline through my jeans, I went to a surgeon. He drained it immediately without any kind of anesthetic and I could have give him a big ole kiss afterwards!! Such relief.

    He did the surgery a couple weeks later and I have never had another problem.

    I understand mostly men get these. Is that true?

    Just found your site and have enjoyed what I have read so far!

  3. It's not true that mostly men get these. Years ago it was but now that there are more women in the workforce, especially in jobs where we are sitting all day, it is much more common in women so only slightly more than half of reported cases of pilonidal cysts are from men. Pilonidal means "nest of hairs" and was originally thought to be cause by in-grown hairs, and they can be, but that's not the only cause.
    Anyway, to make a long story short, I am suffering with one right now and I'm praying that my antibiotics get rid of the infection. I really do not want to have the surgery, nor do I want to have an I&D. :(

  4. dear sad girl,
    please see the following reference if you can. if you can not get in to the site a relevant section is included below. antibiotics are unlikely to resolve your problem. here's to your health.

    Sex: Pilonidal disease in the general population has a male preponderance. It occurs in the ratio of 3 or 4:1. In children, however, the ratio is the opposite occurring in 4 females for each male it afflicts.