A degeneração maligna do cisto pilonidal é rara. O tipo histológico mais freqüente é o carcinoma epidermóide e tem como fator desencadeante o processo inflamatório crônico. O tumor é de crescimento lento. O diagnóstico deve ser precoce e o tratamento cirúrgico adequado é a ressecção ampla incluindo a fáscia pré-sacral. Em alguns casos, como o que apresentamos, o diagnóstico é feito numa fase em que a doença progrediu e invadiu as estruturas adjacentes. Nestes a cirurgia necessária envolve a ressecção multiorgânica. Apresentamos paciente com degeneração carcinomatosa do cisto pilonidal, com doença volumosa que se estendia até a parede do reto. O tratamento realizado foi ressecção alargada, sacralectomia e ressecção abominoperineal do retossigmóide com colostomia definitiva.

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 20th posoperative day due to cardiac complications. This syndrome must be remembered in cases of high obstruction in chronic ill patients.