Hintze Justin M, O'Connor Donal B, Molony Peter, Neary Paul C
Department of Surgery, AMNCH, Tallaght Hospital, Dublin 24, Ireland.
School of Medicine, University of Dublin, Trinity College, Dublin 2, Ireland.
J Surg Case Rep. 2017 Feb 10;2017(2):rjx020. doi: 10.1093/jscr/rjx020. eCollection 2017 Feb.
Small bowel obstructions (SBOs) are common. Adhesions make up the majority of cases at 84.9%, followed by abdominal herniae and malignancies. A 71-year-old female presented with total constipation, abdominal distension, on a background of resected cutaneous melanoma nine years prior. A CT-scan showed small bowel intussusception and disseminated mucosal-enhancing lesions consistent with metastases. She was brought to the operating theatre where six areas of intussusception were identified and manually reduced. Biopsies confirmed the diagnosis of melanoma. Melanoma of the gastrointestinal tract (GIT) is rare, with most cases occurring as metastasis from cutaneous lesions. Melanomas of the GIT are usually asymptomatic in their early stages, and are often diagnosed when complications, such as obstruction or perforation occur. Management of such cases consists mainly of surgical intervention to resolve the complication. In people who present with SBO without previous surgeries or herniae, a malignant cause must be considered.
小肠梗阻(SBO)很常见。粘连占病例的大多数,为84.9%,其次是腹外疝和恶性肿瘤。一名71岁女性,在九年前切除皮肤黑色素瘤的背景下,出现完全便秘、腹胀。CT扫描显示小肠套叠和散在的黏膜强化病变,符合转移表现。她被送往手术室,术中发现六个套叠部位并手动复位。活检确诊为黑色素瘤。胃肠道(GIT)黑色素瘤罕见,大多数病例是皮肤病变转移所致。GIT黑色素瘤早期通常无症状,常在出现梗阻或穿孔等并发症时才被诊断出来。此类病例的治疗主要包括手术干预以解决并发症。对于出现SBO且既往无手术史或无疝的患者,必须考虑恶性病因。