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.

Keywords: Hand-assisted laparoscopy; Ileocolic; Intestinal intussusception; Melanoma; Metastases; Small bowel.

Fig. 1

Pre-operative CT scan of the abdomen. (A) Axial plane images showed a reniform mass with the target sign due to bowel edema in the right lower quadrant suggesting ileocolic intussusception (arrow) as well as the vascular pedicle of the mesentery involved (arrow head). (B) Same features seen after coronal reconstruction.

Fig. 2

Intraoperative photograph indicating ileocolic intussusception (A) and the specimen after surgical reduction prior to resection (B). Metastatic melanoma as an ulcerated polypoid mass is shown as the lead point (arrow head) and vitally recovered distal ileum is seen after reduction (asterisk).

Fig. 3

Operative picture after resection and extracorporeal manual end-to-end anastomosis (circle).