Ileocolic intussusception due to intestinal metastatic melanoma. Case report and review of the literature

Abstract

The small intestine is a frequent site of melanoma metastases and the most common cause of secondary intestinal tumors. Even though, its presentation with intestinal obstruction due to intussusception is very rare. We present a 47-year-old woman with a medical history of facial melanoma operated 17 years ago and recently diagnosed of cervical recurrence who complained of abdominal pain of one week duration accompanied with vomiting and abdominal distension. Computed tomography (CT) scan revealed marked distension of the small intestine with features suggesting intussusception of the distal ileum. At laparoscopic exploration a massive ileocolic intussusception was found with invagination of the last 60 cm of ileum inside the cecum and ascending colon. Surgical reduction revealed a tumor of approximately 2 cm in the distal end of the intussuscepted intestine acting as the lead point. Resection of non-viable ileum along with the tumor and end-to-end anastomosis was performed. Many other lesions of smaller size were found distantly in the proximal small bowel but were not treated. The patient had a full recovery and was discharged three days after surgery. Pathological examination showed metastatic melanoma and a positron emission tomography (PET) scan confirmed disseminated disease with brain metastasis. The patient died three months after surgery. Intestinal occlusion due to metastatic disease is a rare condition but should be taken into account particularly in patients with history of cancer. Surgical intervention with a mini-invasive laparoscopic approach is feasible. Intestinal resection and anastomosis is mandatory for either curative or palliative intentions providing a satisfactory treatment.

Adult intussusception: a single-center 10-year experience

“…In our study, treatment of choice for all patients was surgery, with nearly all cases (93.8 %, n = 15) requiring emergency surgery, as previously reported [32], and 37.5 % (n = 6) undergoing segmental small bowel resection. Although there is no consensus regarding the optimal surgical approach, and there is still controversy about reduction before resection [32], several authors suggest resection as the best treatment option in adults, given nearly half of colonic and enteric intussusceptions are associated with malignancies [3,33].…”

“…Although there is no consensus regarding the optimal surgical approach, and there is still controversy about reduction before resection [32], several authors suggest resection as the best treatment option in adults, given nearly half of colonic and enteric intussusceptions are associated with malignancies [3,33]. Moreover, due to the several risks and severe complications associated with intussusceptions and their delayed treatment such as intraluminal seeding and dissemination, perforation and peritoneal dissemination with edematous, and fragile bowel wall [34,35], most surgeons recommend surgery regardless of the nature of their cause [36,37].…”

Melanoma metastases in the abdomen and pelvis: Frequency and patterns of spread

“…Melanoma is a tumor which is known to widely metastasize, involving organs which are not commonly involved by other tumors [12][13][14] . For example, melanoma accounts for more than 50% of metastases to the gallbladder ( Figure 5) and is the second most common metastasis to the spleen and the third most common to the testicle (Figure 6) [15][16][17][18][19] .…”

Ileocecal Intussusception Secondary to Bowel Metastases from Cutaneous Melanoma: Case Report

“…Although a limited number of studies, intestinal obstruction secondary to intussusception is the most frequent clinical presentation of primary melanoma. 1,9,10,11,12 The presentation of our patient was ileocecal intussusception due to metastatic melanoma of the intestines.…”