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Primary melanomas of small intestine are rare and most of them are metastases from cutaneous melanoma. The features distinguishing primary from metastatic intestinal melanoma are still under debate. Primary intestinal melanoma (PIM) is associated with a worse prognosis and a more aggressive behaviour due to its rapid growth. Hence, we report a case of primary ileal melanoma presenting as intussusception with generalized lymph node metastasis. A 69-year-old lady presented with recurrent abdominal pain, vomiting, distension and low grade fever. On examination, a 4*4 cm right inguinal lymph node was noted with no abnormalities on abdominal and per rectal examination. Computed tomography (CT) revealed ileoileal intussusception which was confirmed on laparotomy and diagnosed as primary ileal melanoma on histopathological examination (HPE). Whole-body Positron Emission Tomography (PET) CT revealed metastasis to lymph nodes all over the body. Intestinal melanomas are rare and mostly occur secondary to primary cutaneous melanoma. The clinical picture of intestinal melanoma is varied, ranging from chronic vague symptoms to surgical emergency such obstruction and bleeding. Treatment of both primary as well as metastatic intestinal melanoma is surgical excision. Intestinal melanoma, in general, carries a bad prognosis than cutaneous melanoma. Owing to the rarity and vague presentation, early diagnosis of intestinal melanoma requires a high index of suspicion, multimodal imaging and timely surgical intervention with adequate resection margins.

Objective: The aim of this study was to identify the factors predicting prolonged hospitalization following abdominal wall hernia repair. Material and Methods: This was a prospective observational study which included patients operated for elective and emergency abdominal wall hernias. Details of the patients including demographic profile, hernia characteristics, and perioperative factors were collected. Patients were followed up till discharge from the hospital to record the postoperative local and systemic complications. Patients who stayed for more than three days were considered as longer hospital stay. Analysis was performed to identify factors associated with the longer hospital stay. Results: A total of 200 consecutive patients of abdominal wall hernia were included over a period of two years. Female sex (p< 0.05), obesity (p= 0.022), and smoking and alcohol consumption (0.002) led to a prolonged hospital stay. Patients with incisional hernias (p< 0.05), American Society of Anesthesiologists (ASA) class of two or more (p= 0.002), complicated hernia (p= 0.007), emergency surgeries (p= 0.002), general anesthesia (p= 0.001), longer duration of surgery (>60 minutes, p< 0.05), usage of drain (p< 0.05), and surgical site infection (SSI, p= 0.001) were significantly associated with increased length of hospital stay. Whereas, age distribution, socio-economic status, co-morbidities, recurrent surgery, type of hernia repair and the level of surgeon did not affect the length of hospital stay. Conclusion: The risk factors associated with prolonged hospital stay in patients undergoing abdominal wall hernia repair were female sex, obesity, smoking and alcoholism, incisional hernia, complicated hernias, higher ASA class, and prolonged duration of surgeries.

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