Small bowel intussusception secondary to metastatic melanoma 15 years after complete excision of the primary tumor

Vigorita, Vincenzo; Ausania, Fabio; Zoccali, Marco; Alvarez, C. Facal; Nadal, Blanca De Urrutia; Núñez, José Enrique Casal

doi:10.1016/j.ijscr.2014.11.060

Cited by 9 publications

(15 citation statements)

References 15 publications

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“…Small bowel represents the second most frequently involved organ after liver. The average time elapsed excision of primary cutaneous melanoma and the onset of bowel metastasis is about 3-6 years, although have been described cases of synchronous metastases or within 6 months of diagnosis, with a mean symptom-free interval between 6 and 90 months [5]. Diagnosis is often delayed due to the course of the disease which is usually asymptomatic in the early stage, or associated with a specific abdominal symptoms such as abdominal pain, intestinal obstruction, lower gastrointestinal bleeding (overt or occult) [1,6,7].…”

Section: Discussionmentioning

confidence: 99%

Video Capsule Endoscopy is useful in the Management of Metastatic Malignant Melanoma?

Saglio¹

2015

GHOA

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The incidence of melanoma has been increasing over the years. Mortality and morbidity remains high despite new therapies. Dissemination occurs primarily by the lymphatic route and than by hematogenous route. Gastrointestinal metastases do occur, but they are mainly intraluminal mucosal melanomas. We report a case of a man of 52 years old with a history of respected cutaneous melanoma who presented with rectal bleeding followed by recurrent episodes of melena, weight loss and severe anemia. Esophagogastroduodenoscopy and colonoscopy were performed without detecting any alteration except for the presence of a chronic atrophic gastritis, so a video capsule endoscopy was performed which showed, in the early jejunum, a substenosis from melanoma metastases associated with satellite lesions of whole jejunum. The patient was operated after being subjected to a computed tomography for staging the disease, but died after three months for the spread of disease. Since the melanoma incidence is rising, similar cases may present in the near future. This emphasizes the importance of a comprehensive study of the entire gastrointestinal tract endoscopy, highlighting the role of video capsule endoscopy as easy, noninvasive, and effective diagnostic procedures to carefully study the small bowel.

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Section: Discussionmentioning

confidence: 99%

Video Capsule Endoscopy is useful in the Management of Metastatic Malignant Melanoma?

Saglio¹

2015

GHOA

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“…Symptomatic patients can present with clinical signs and symptoms of bowel obstruction, including abdominal pain or cramping, nausea, vomiting or bleeding . In such situations, resection of the involved bowel is often required, though it is frequently only palliative, secondary to the presence of additional sites of disease . In contrast, the management of imaging findings concerning for intussusception in asymptomatic patients is not clear.…”

Section: Introductionmentioning

confidence: 99%

“…10 In such situations, resection of the involved bowel is often required, though it is frequently only palliative, secondary to the presence of additional sites of disease. 11 In contrast, the management of imaging findings concerning for intussusception in asymptomatic patients is not clear. While radiographic findings concerning for intussusception may resolve spontaneously on subsequent imaging in some patients, others may go on to develop symptoms requiring urgent intervention.…”

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Management of intussusception in patients with melanoma

Perez

Sun

Farley

et al. 2019

Journal of Surgical Oncology

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Background Increased cross‐sectional imaging for surveillance of metastatic melanoma has led to more diagnoses of asymptomatic intussusception. Methods We performed a multi‐institutional retrospective review of patient records with a history of metastatic melanoma and a diagnosis of intussusception. Patients were divided into three groups: 1) asymptomatic patients without current evidence of melanoma (no evidence of disease [NED]); 2) asymptomatic intussusception and known active metastatic melanoma; 3) symptomatic intussusception and known active metastatic melanoma; the number of patients requiring surgery and intraoperative findings were recorded. Results We reviewed 73 patients diagnosed with intussusception from 2004 to 2017. Among asymptomatic patients with NED (n = 16), 14 spontaneously resolved and 2 underwent pre‐emptive surgery without abnormal intraoperative findings. Of asymptomatic patients with active metastatic disease (n = 32), 25 were initially observed and 7 underwent pre‐emptive surgery and 9 of the 25 initially observed patients required surgery for development of symptoms. In this group, all 16 patients undergoing surgery (50% of the group) had intraoperative findings of intussusception and/or metastatic intestinal melanoma.. All symptomatic patients with metastatic melanoma (n = 25) underwent surgery; all had intraoperative findings of intussusception and/or metastatic melanoma except 1 (Meckel's diverticulum). Conclusion Asymptomatic patients with NED do not require surgery and intussusception will likely resolve spontaneously. Asymptomatic patients with known metastatic melanoma may be initially observed, but a low threshold for surgery should be maintained. Symptomatic patients with known metastases should undergo surgery.

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“… 2 The time from index surgery, that is, the excision of cutaneous malignant melanoma, to the presentation of symptomatic enteric metastases has been reported to vary from 2 months to 15 years. 4 Clinical presentation is varicolored depending on the site and complications of intussusception. Abdominal ultrasonography is considered to be a useful tool which can reveal the intussuscept as a “target” or “pseudo-kidney” sign.…”

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confidence: 99%

“…Abdominal ultrasonography is considered to be a useful tool which can reveal the intussuscept as a “target” or “pseudo-kidney” sign. 2 3 4 Abdominal computed tomography and capsule endoscopy have also been shown to be beneficial test in revealing intestinal melanoma. Such as in our case, in emergency cases where acute intussusception presents with intestinal obstruction with hydroionic imbalance, the diagnosis is established intraoperatively.…”

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confidence: 99%

Ileoileal intussusception caused by the metastasis of cutaneous malignant melanoma to the small bowel 6 years after its excision presenting with small bowel obstruction

Gachabayov

2017

Niger Med J

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Small bowel intussusception secondary to metastatic melanoma 15 years after complete excision of the primary tumor

Abstract: HIGHLIGHTSGastrointestinal tract recurrences from cutaneous melanoma are not uncommon.Patients may present with anemia and/or melena or with obstructive symptoms.Surgical resection provides effective palliation and, potentially, improves survival.

Cited by 9 publications

References 15 publications

Video Capsule Endoscopy is useful in the Management of Metastatic Malignant Melanoma?

Video Capsule Endoscopy is useful in the Management of Metastatic Malignant Melanoma?

Management of intussusception in patients with melanoma

Ileoileal intussusception caused by the metastasis of cutaneous malignant melanoma to the small bowel 6 years after its excision presenting with small bowel obstruction

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