CASE REPORT
Acute ileo-ileal intussusception due to intestinal metastatic melanoma
 
More details
Hide details
1
Department of Digestive Surgery, Tenon Hospital, Paris, France
2
Department of General Surgery, Habib Bourguiba Hospital, Sfax, Tunisia
CORRESPONDING AUTHOR
Ahmed Guirat   

Department of Digestive Surgery, Tenon Hospital, 4 Rue de la Chine, 75020 Paris, France. Tel.: +33 633 72 62 05; fax: +33 156 01 70 00.
Submission date: 2014-04-24
Acceptance date: 2015-03-09
Online publication date: 2015-04-19
Publication date: 2020-03-24
 
Pol. Ann. Med. 2015;22(1):41–44
 
KEYWORDS
ABSTRACT
Introduction:
Although gastrointestinal tract is a fairly frequent site of melanoma metastases, reports of small bowel intussusception caused by melanoma metastasis are very rare.

Aim:
To describe a rare complication of metastatic melanoma and to expose the difficulties to screen digestive metastases of melanoma.

Case study:
We report the case of a 69-year-old woman who was admitted for abdominal pain, melanoma and anemia. She had a history of surgery for a malignant vulval melanoma one year earlier and had been treated with adjuvant interferon a. Computed tomography (CT) concluded to a small bowel intussusception. Exploratory laparoscopy revealed a large tumor arising from the proximal small bowel. Jejunal resection with an end-to-end anastomosis was performed. Histological examination showed a metastasis of malignant melanoma. Regular postoperative follow-up did not show any sign of recurrence.

Results and discussion:
Gastrointestinal metastases are a vicious site of distant localization of melanoma, difficult to diagnose and life-threatening due to their potential complications. Symptoms are often nonspecific. Rarely complications such as intussusception can be the first clinical presentation. CT, CT enteroclysis, fluorodeoxyglucose-positron emission tomography scan and capsule endoscopy may result as very useful for detecting gastrointestinal metastases.

Conclusions:
Any gastrointestinal symptom in patients previously treated for cutaneous melanoma should lead to accurate research for metastases. We propose to use at follow-up abdominal CT scan in asymptomatic patients when the primary tumor has poor prognostic factors such as advanced stage or incomplete resection.

CONFLICT OF INTEREST
None declared.
 
REFERENCES (19)
1.
Benaissa A, Fornès P, Ladam-Marcus L, Grange F, Amzallag- Bellenger E, Hoeffel C. Multimodality imaging of melanoma metastases to the abdomen and pelvis. Clin Imaging. 2011;35(6):452–458.
 
2.
Dequanter D, Sales F, Legendre H, Lothaire P, Pector JC. Surgical resection for gastrointestinal metastatic melanoma. Ann Chir. 2004;129(5):278–281.
 
3.
Garbe C, Peris K, Hauschild A, et al. Diagnosis and treatment of melanoma: European consensus-based interdisciplinary guideline. Eur J Cancer. 2010;46(2):270–283.
 
4.
Buzzell RA, Zitelli JA. Favourable prognostic factors in recurrent metastatic melanoma. J Am Acad Dermatol. 1996;34(5 Pt 1):798–803.
 
5.
Schwartz A, Scheffler M, Gineste JC, Saric J. Small intestinal metastasis from malignant melanoma. Presse Med. 2010;39(12):1344–1345.
 
6.
Alvarez FA, Nicolás M, Goransky J, Vaccaro CA, Beskow A, Cavadas D. Ileocolic intussusception due to intestinal metastatic melanoma. Case report and review of the literature. Int J Surg Case Rep. 2011;2(6):118–121.
 
7.
Aminian A, Karimian F, Mirsharifi R, et al. Significance of platelet count in esophageal carcinomas. Saudi J Gastroenterol. 2011;17(2):134–137.
 
8.
Kadri N, Marie I, Chassagne P, Trivalle C, Doucet J, Bercoff E. Small bowel metastasis disclosing malignant melanoma. Rev Med Interne. 1995;16(4):278–279.
 
9.
Lens M, Bataille V, Krivokapic Z. Melanoma of the small intestine. Lancet Oncol. 2009;10(5):516–521.
 
10.
Lesur G, Bourgault I, Longvert C, et al. Rectosigmoid junction metastasis from melanoma: a case report. Gastroenterol Clin Biol. 2009;33:93–96 [in French].
 
11.
Von Holzen U, Viehl CT, Hamel CT, Oertli D. Ileal intussusception due to visceral malignant melanoma metastasis. Surgery. 2009;145(3):339–340.
 
12.
Ollila DW. Complete metastasectomy in patients with stage IV metastatic melanoma. Lancet Oncol. 2006;7(11):919–924.
 
13.
Prakoso E, Fulham M, Thompson JF, Selby WS. Capsule endoscopy versus positron emission tomography for detection of small-bowel metastatic melanoma: a pilot study. Gastrointest Endosc. 2011;73(4):750–756.
 
14.
Albert JG, Helmbold P. Diagnosis of intestinal metastases from malignant melanoma. Dtsch Med Wochenschr. 2012;137(9):431–436.
 
15.
Rodriguez Rivera AM, Alabbas H, Ramjaun A, Meguerditchian AN. Value of positron emission tomography scan in stage III cutaneous melanoma: a systematic review and meta-analysis. Surg Oncol. 2014;23(1):11–16.
 
16.
Sanki A, Scolyer RA, Thompson JF. Surgery for melanoma metastases of the gastrointestinal tract: indications and results. Eur J Surg Oncol. 2009;35(3):313–319.
 
17.
Fletcher JW, Djulbegovic B, Soares HP, et al. Recommendations on the use of 18F-FDG PET in oncology. J Nucl Med. 2008;49(3):480–508.
 
18.
Atiq O, Khan AS, Abrams GA. Metastatic amelanotic melanoma of the jejunum diagnosed on capsule endoscopy. Gastroenterol Hepatol. 2012;8(10):691–693.
 
19.
Sasse AD, Sasse EC, Clark LG, Ulloa L, Clark OA. Chemoimmunotherapy versus chemotherapy for metastatic malignant melanoma. Cochrane Database Syst Rev. (1):2007:CD005413.