Jaqueline Velkoski*, Federica Maffeis, Stefano Basso and Paolo Ubiali
Department of General Surgery, Clinic and Liver Transplant Center, University Hospital of Udine, ItalyFulltext PDF
Background: Gastrointestinal metastases from malignant melanoma are recognized in 60% of autoptic cases, but become symptomatic only in 0.8% to 9% of patients. Case Report: We report the case of a 51 year-old women, complaining of vague abdominal pain arisen from few weeks, who was admitted to the emergency room for vomiting and worsening abdominal pain. The investigations revealed microcytic anemia and a radiological picture of suspected multiple intussusceptions resulting in intestinal obstruction. She underwent emergency surgery, which revealed three polypoid formations of the small bowel and grayish mesenteric lymphadenomegalies. Double intestinal resection and lymph node biopsy were performed. The histological examination showed the presence of intestinal and lymph node localizations of malignant melanoma, more likely metastatic in nature. Discussion: The small bowel is the most frequent site of gastro-intestinal metastases from malignant melanoma (71% to 91%). These only rarely cause symptoms including abdominal pain, vomiting and anemia. The diagnosis is based on radiological and endoscopic findings and requires histological confirmation. In 2% of cases the primitive is not detectable. Immunotherapy and molecular target therapies are the preferred systemic options, but surgical resection guarantees the best prognostic results. Conclusion: Intestinal intussusception in adults is a rare pathology, which can hide malignant neoplasms. Among these, even in the absence of a history of skin pathology, gastrointestinal metastases from melanoma should be considered, especially in patients with abdominal symptoms and anemia that cannot otherwise be explained. Surgical resection not only resolves the symptoms, but can reveal unexpected diagnoses.
Melanoma; Gastro-intestinal metastases; Bowel obstruction; Intussusception; Anemia
Velkoski J, Maffeis F, Basso S, Ubiali P. Where You Less Expect It: A Rare Case of Intestinal Intussusception. World J Surg Surgical Res. 2022; 5: 1380..