Malignant degeneration of pilonidal cysts is rare. The most common histologic type is
the squamous cell carcinoma, triggered by the chronic inflammatory process. The
growth of the lesion is typically slow. The diagnosis must be early and the
appropriate treatment is ample surgical resection, including the presacral fascia. In
some cases, as the present one, the diagnosis is made at a stage when the disease has
progressed and invaded adjacent structures. In these cases the surgery involves
multiple organ resection. We report the case of a patient with carcinomatous
degeneration of pilonidal cyst, with bulky disease that extended up to the wall of
the rectum. The treatment was extended resection, sacrectomy and abominoperineal
resection of the rectosigmoid with permanent colostomy.
The Superior Mesenteric Syndrome is a rare and controversial disease. The compression of the duodenum by the mesenteric artery and aorta causes an intermitent obstruction. Preoperative diagnosis is very difficult.We present one case of this syndrome in a pacient with severe weight loss and signs of high intestinal obstruction. The diagnosis was based on clinical and radiologic findings. A duodenojejunostomy was performed after medical treatment failure.This patient died on the 20 th posoperative day due to cardiac complications. This syndrome must be remembered in cases of high obstruction in chronic ill patients.
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