Multiple small-bowel intussusceptions caused by metastatic malignant melanoma
Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.American journal of surgery (Impact Factor: 2.29). 06/2008; 196(3):e1-2. DOI: 10.1016/j.amjsurg.2007.05.062
Intussusceptions of the small bowel, along with multiple intraluminal metastatic tumors, were noted during surgery. A segmental resection of the small bowel was performed, and the histologic diagnosis of metastatic melanoma was made. Long-term survival remains poor; therefore, complete surgical resection of macroscopic tumors remains the best treatment of choice.
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ABSTRACT: Malignant melanomas have a predilection to metastasize to the small bowel. Three patients with malignant melanoma involving the small bowel are reported. Two patients were operated on for small bowel obstruction and the third for gastrointestinal bleeding with anemia. Two patients remained well 6 month and 2 years, respectively, after surgery. One patient died of metastatic cerebral melanoma 6 months postoperatively. One should suspect small bowel metastasis in every patient with malignant melanoma in his past medical history, who presents with recent changes in bowel habits, intestinal obstruction or gastrointestinal bleeding. Preoperative assessment can only raise the suspicion, even with advanced imaging methods: capsule endoscopy, enteroscopy, CT or PET-CT. The only therapeutic procedure is surgical resection, offering both short term survival as well as an improvement in the quality of life. Although prognosis is dismal there are factors associated with prolonged survival: complete surgical resection with no residual primary or metastatic tumor, so-called primary small bowel tumors in patients aged more then 60 years, LDH < 200 U/L, lack of tumor spread in mesenteric lymph nodes.
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