Cibulas Megan A, Carrillo Eddy H, Lee Seong K, Rosenthal Andrew A
Department of Surgery, 3932Memorial Healthcare System General Surgery Residency Program, Hollywood, FL, USA.
Division of Trauma and Acute Care Surgery, 3932Memorial Healthcare System, Hollywood, FL, USA.
Am Surg. 2022 May;88(5):1024-1025. doi: 10.1177/00031348211054552. Epub 2022 Mar 20.
Intussusception is uncommon in adults, and usually secondary to a neoplasm. Small bowel obstruction (SBO) is prevalent in adults but rarely due to intussusception. A 55-year-old woman with history of melanoma (four years in remission) presented with abdominal pain and melena. Upper and lower endoscopy was normal. She developed bilious emesis and worsening pain, so she presented to the emergency department. CT abdomen/pelvis identified a SBO with transition point at a small bowel intussusception; she was taken to the operating room. A mid-jejunal intussusception was reduced revealing a mass; resection and primary anastomosis was performed. Final pathology demonstrated a 5.5 cm melanoma, likely metastatic. She required no additional therapy and remains in remission eighteen months later. Intussusception due to metastatic melanoma is rare but should be on the differential for patients with SBO and history of melanoma. Knowledge of this history should prompt consideration for oncologic resection to optimize outcome.
肠套叠在成人中并不常见,通常继发于肿瘤。小肠梗阻(SBO)在成人中很常见,但很少由肠套叠引起。一名有黑色素瘤病史(缓解四年)的55岁女性出现腹痛和黑便。上消化道和下消化道内镜检查均正常。她出现胆汁性呕吐且疼痛加重,于是前往急诊科就诊。腹部/盆腔CT检查发现小肠梗阻,梗阻部位为小肠套叠;她被送往手术室。空肠中段的肠套叠复位后发现一个肿块;进行了切除和一期吻合术。最终病理显示为一个5.5厘米的黑色素瘤,可能已转移。她无需额外治疗,18个月后仍处于缓解状态。转移性黑色素瘤导致的肠套叠很少见,但对于有小肠梗阻和黑色素瘤病史的患者应考虑到这种可能性。了解这一病史应促使考虑进行肿瘤切除以优化治疗结果。