HighlightsGiant digital fibrokeratoma, nail like changes, benign growth, surgical excision.

Sacrococcygeal pilonidal disease presentation varies greatly between being asymptomatic, acute abscess and chronic sinus. Acute abscess constitutes almost half of the initial presentation of such disease. To our best knowledge, acute abscess presentation hasn’t been reported as a result of acute trauma in the literature. In this paper, we report a case of atypical presentation of sacrococcygeal pilonidal disease after a fall on the back a week earlier. Surgical management of the abscess, incidental finding of the pilonidal disease and lessons learned fr om such case is discussed in detail.