Pilonidal disease comprises a spectrum of clinical presentations, ranging from asymptomatic hair containing cysts and sinuses to large symptomatic abscesses that have some tendency to recur. It is commonly encountered in the sacrococcygeal region but rarely in the umbilicus. We report a case of umbilical pilonidal cyst in an 18 year old hairy adolescent male who presented with pain, redness, swelling and discharge from the umbilicus. An abdominal ultrasonography showed an abscess cavity in the

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... ubcutaneous tissue of the umbilicus. Cyst excision with reconstruction of the umbilicus was carried out and the microscopic findings revealed umbilical pilonidal cyst. This article outlines the pathophysiology, differential diagnosis, microscopic features and management of this rare disease. Due to the risk of peritoneal extension of inflammation from this lesion, conservative treatment is not acceptable. Surgery is the choice of treatment.