Small bowel malignant melanoma presenting as a perforated jejunal diverticulum: a case report and literature review

Abstract

Although usually harmless and asymptomatic, jejuno-ileal diverticulae are associated with various non-specific gastrointestinal symptoms, and rarely cause surgical emergencies. This case report describes the presentation and management of a patient with an acute abdomen, whose jejunal diverticulum was perforated. Unexpectedly, histopathological assessment demonstrated malignant melanoma lining the diverticulum. Whether this was primary or metastatic is discussed, together with a synopsis of the literature on small bowel diverticulae.

Keywords: intestinal perforation; jejunal diverticulum; malignant melanoma.

Figure 1

The initial chest X-ray showed a raised right hemidiaphragm but no free air (a). The first CT scan showed a fluid-filled diverticulum continuous with the small bowel (b), along with extraluminal air and fluid, and portal venous air within the left lobe of the liver (c). The mucosal lining of the perforated diverticulum was necrotic and had a brown hue (d). The second CT scan extended into the chest and showed consolidation and a necrotic cystic lesion in the right lung (e). Histopathological assessment showed full-thickness infiltration of tumour across the bowel wall (f), staining for Melan A (inset; high magnification).