Pacilli Mario, Gerundo Alberto, Pavone Giovanna, Fersini Alberto, Ambrosi Antonio, Tartaglia Nicola
Department of Medical and Surgical Sciences, University of Foggia, Luigi Pinto Street, No. 1, 71122 Foggia, Italy.
Department of Medical and Surgical Sciences, University of Foggia, Luigi Pinto Street, No. 1, 71122 Foggia, Italy.
Int J Surg Case Rep. 2023 Apr;105:107986. doi: 10.1016/j.ijscr.2023.107986. Epub 2023 Mar 17.
Metastatic localization of melanoma often affects the gastrointestinal tract, with reference to the small intestine.
In this work we present the clinical course of a patient affected by a surgically treated melanoma of the right conjunctiva, suddenly manifesting abdominal symptomatology. The abdominal computed tomography scan (CT scan) show evidence of free air into the peritoneal cavity, cholecystitis and brain lesions highly suspicious for metastases. Patient underwent emergency surgery, consisting of ileo-cecal resection, cholecystectomy, with the construction of an ileostomy. The histological examination diagnosed multiple ileal and gallbladder localizations of pigmented epithelial melanoma, and localization.
The treatment of conjunctival melanoma consists in surgical removal. Distant metastases frequently affect the gastrointestinal tract, leading to the necessity to assess patients with abdominal symptoms, in order to avoid emergency scenarios such as the one reported in our study.
Intra-abdominal metastases from melanoma are an event that should not be underestimated, because if detected in time, they can be treated with surgery resulting in a clear improvement in the prognosis. Late diagnosis of intestinal metastases can cause an acute abdomen scenario frequently caused by intestinal obstruction or gastrointestinal bleeding.
黑色素瘤的转移定位常累及胃肠道，尤其是小肠。
在本研究中，我们呈现了一名接受手术治疗的右结膜黑色素瘤患者的临床病程，该患者突然出现腹部症状。腹部计算机断层扫描（CT扫描）显示腹腔内有游离气体、胆囊炎以及高度怀疑为转移灶的脑部病变。患者接受了急诊手术，包括回盲部切除术、胆囊切除术，并进行了回肠造口术。组织学检查诊断为色素上皮黑色素瘤的多个回肠和胆囊定位。
结膜黑色素瘤的治疗方法为手术切除。远处转移常累及胃肠道，因此有必要对出现腹部症状的患者进行评估，以避免出现如我们研究中所报告的紧急情况。
黑色素瘤的腹内转移是一个不可低估的情况，因为如果及时发现，可通过手术治疗，从而明显改善预后。肠道转移的晚期诊断可能导致由肠梗阻或胃肠道出血频繁引发的急腹症情况。
