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Small-bowel intussusception secondary to metastatic melanoma.

A 39-year-old woman was referred to our department inJune 2004 with a 1-month history of anemia, recurrent ab-dominal pain, and abdominal distention. She had had a ma-lignant melanoma excised from her back with a sentinelnode biopsy in the axilla, which was considered positive formicrometastases (June 2003); the patient received Kirkwoodinterferon-α2b adjuvant therapy for one year with good tol-erance.Abdominal ultrasounds revealed a mass in the right iliacfossa, and a CT scan showed submandibular nodes as wellas small-bowel intussusception at the ileum, with a largenodular tumor in this same site (Fig. 1). A surgical explo-ration was decided upon. Laparotomy revealed intussuscep-tion of the lower ileum (Fig. 2b.), which was caused bymultiple large polypoid lesions (Fig. 2a) accompanied byenlarged mesenteric lymph nodes. We performed a righthemicolectomy and resected 70 cm from the affected smallbowel and involved mesentery, followed by a side-to-sideileocolic stapled anastomosis. The pathology report con-firmed the presence of various exophytic polypoid tumorspartially occluding the lumen, which were invading the sub-mucosa. Mesenteric lymph nodes were also invaded by the same tumor, which proved to be a metastatic melanoma (pos-itive for S-100 and HMB-45).