Cáncer escamoso asentado sobre sinus pilonidal recurrente: la evolución de una patología benigna y frecuente a una causa de muerte infrecuente / Squamous cancer settled on recurrent pilonidal sinus: the evolution of a benign and frequent pathology to an infrequent cause of death

El sinus pilonidal es una patología frecuente cuya malignización es infrecuente aunque su pronóstico puede ser fatal. El objetivo de esta publicación es presentar un caso de un paciente intervenido en múltiples ocasiones de escisiones de sinus pilonidal con degeneración maligna del mismo y evolución fatal, con el fin de recalcar la importancia del examen anatomopatológico sistemático de todas las muestras de escisión quirúrgica. (AU)

The pilonidal sinus is a frequent pathology whose malignization is uncommon although its prognosis can be fatal. The objective of this publication is to present a case of a patient intervened on multiple occasions of pilonidal sinus excisions with malignant degeneration and fatal evolution, in order to emphasize the importance of the systematic pathological examination of all surgical excision samples. (AU)

Dufourmentel rhomboid flap for sacrococcygeal pilonidal sinus: technical details / Técnica quirúrgica del colgajo de Dufourmentel para el tratamiento de la enfermedad pilonidal sacro-coccígea

Sacrococcygeal pilonidal disease (SPD) is a chronic an uncommon entity with a variety of alternatives for treatment. One of those is the excision of the sinus tract followed by a reconstruction with the rhomboid flap described by Dufourmentel. The aim of this paper is to describe the main phases of the technique. A detailed explanation of the key steps for the implementation of Dufourmentel flap for the treatment of SPD is exposed. Excision of sacrococcygeal pilonidal sinus followed by Dufourmentel rhomboid flap is an alternative to consider in the treatment of pilonidal disease.

La enfermedad pilonidal sacrococcígea (EPS) es una entidad clínica crónica e infrecuente. Para su tratamiento se han descrito numerosas alternativas. Una de ellas es la exéresis de la zona afectada seguida de un cierre primario sin tensión, por medio de un colgajo romboidal descrito por Dufourmentel. El objetivo de este artículo es describir las fases más relevantes de la técnica. Se realiza una detallada explicación de los pasos clave para ejecutar la exéresis romboidal de la zona afectada, con la ulterior rotación de un colgajo de Dufourmentel para el tratamiento de la EPS. La exéresis romboidal de EPS seguida de la rotación de un colgajo de Dufourmentel constituye una alternativa a considerar en el tratamiento de la EPS.

Umbilical Pilonidal Sinus: A Rare Presentation.

Pilonidal sinus is common in the sacrococcygeal region. It is rare at the umbilicus. Incidence being 0.6%, we report a case of umbilical pilonidal sinus treated in our hospital. A 20-year-old male patient was admitted to our hospital with complaints of purulent discharge from the umbilicus since 3 months. Patient was posted for omphalectomy. Intraoperatively, a tuft of hair was found in a sinus tract communicating with the umbilicus. Histopathological evaluation was compatible with pilonidal sinus disease. There are only a few reports of the umbilical pilonidal sinus in the literature. Umbilical sinus tract differs from the sacrococcygeal variety in the absence of multiple tracts and low recurrence rates. Treatment options and differential diagnosis are discussed in the article.

Carcinomatous degeneration of pilonidal cyst with sacrum destruction and invasion of the rectum / Degeneracao carcinomatosa do cisto pilonidal com destruicao do sacro e invasao da parede do reto

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.

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.

Quiste pilonidal gigante en un anciano / Giant pilonidal cyst in an elderly man

Se describe el caso clínico de un anciano con quiste pilonidal gigante, cuya información primaria al respecto se obtuvo de la labor de terreno realizada por su médico de familia y anotada en la historia clínica individual del paciente, el cual fue intervenido quirúrgicamente y con éxito en el Servicio de Coloproctología del Hospital General Docente Dr Juan Bruno Zayas Alfonso de Santiago de Cuba en enero de 2010, cuando se efectuó la exéresis total del tumor sin lesionar el recto.

A case report of an elderly man with a giant pilonidal cyst, whose primary data was obtained through a medical visit carried out by the physician of the doctor's office where he belongs and written down in his medical record, is described. This patient was surgically treated with success at the Coloproctology Service from Dr Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba on January, 2010 when total tumor exeresis was carried out without injuring the rectum.

Enfermedad pilonidal sacrococcígea: técnica de Karydakis versus Limberg flap / Sacrococcygeal pilonidal disease: results of Karydakis flap vs. Limberg flap

Comparar la técnica de Karydakis versus la técnica del colgajo romboidal (Limberg Flap) en el tratamiento de la enfermedad pilonidal sacrococcígea para determinar si la realización de la técnica de Karydakis reduce los índices de complicaciones post-quirúrgicas de esta patología (recurrencia y formación de fístulas o abscesos).

To compare Karydakis technique versus rhomboid flap (Limberg flap) technique in the treatment of sacrococcygeal pilonidal disease to determine whether of this technique reduces the complications rates of this desease (recurrence and fistula formation or abscess).

Cisto Sacrococcigeo: analise de 183 casos / Sacrococcygeal cyst: analisis of 183 cases

Este estudo consta de uma analise retrospectiva de 183 pacientes portadores de cisto sacrococcigeo, submetidos a tratamento cirurgico nos Hospitais de Caridade e Universitario, de Florianopolis, SC, no periodo compreendido entre marco de 1973 e junho de 1989. Foram analisados o tempo de permanencia hospitalar, presenca ou nao de abcesso anterior, incidencia da patologia em relacao a sexo, faixa etaria, tecnica cirurgica adotada e complicacoes pos-operatorias, enfatizando-se a recidiva local da patologia.