Adolescent Gluteal Cleft Pathologies Not Due to Pilonidal Disease: A Case Series and Diagnostic Algorithm

Area of Science:

• Pediatric Surgery
• Adolescent Medicine
• Dermatology

Background:

• Gluteal cleft pathologies in adolescents can be misdiagnosed as pilonidal disease.
• It is crucial to distinguish pilonidal disease from other non-pilonidal conditions affecting the gluteal cleft.
• This study focuses on adolescent patients presenting with non-pilonidal gluteal cleft pathologies.

Purpose of the Study:

• To identify and characterize non-pilonidal diseases presenting in the gluteal cleft of adolescent patients.
• To develop a diagnostic algorithm for differentiating various gluteal cleft pathologies in adolescents.
• To aid clinicians in accurate diagnosis and management of pediatric gluteal cleft conditions.

Main Methods:

• Retrospective review of patients presenting to a pediatric Pilonidal Clinic from January 2019 to December 2023.
• Inclusion criteria: patients requiring work-up for diseases distinct from pilonidal disease.
• Data collected included demographics, clinical work-up, and treatment outcomes.

Main Results:

• Twenty-one adolescent patients with non-pilonidal diagnoses were identified.
• Diagnoses included neurological diseases (4), dermatological conditions (7), inflammatory bowel disease (5), sacral dimples (4), and a sacral pressure ulcer (1).
• Diagnostic decisions were guided by wound characteristics, immobility history, gluteal cleft findings, and clinical symptoms.

Conclusions:

• A practical diagnostic algorithm was developed for differentiating gluteal cleft pathologies in adolescents.
• The algorithm encompasses dermatologic, colorectal, neurologic, and traumatic causes.
• This tool assists in distinguishing non-pilonidal conditions from pilonidal disease in pediatric patients.