Ng Yuki J, Loc Leong J, Bun Kuek S, Mushtaq Sohail
General Surgery, Sarawak General Hospital, Jalan Hospital, 93586 Kuching, Sarawak, Malaysia.
International Student Surgical Network Malaysia, Kuala Lumpur, Malaysia.
J Surg Case Rep. 2023 Oct 17;2023(10):rjad572. doi: 10.1093/jscr/rjad572. eCollection 2023 Oct.
About 5% of all intussusception are found in adults, up to 90% of these have an anatomical lesion with ~50% of them are malignant. Malignant melanoma commonly metastasizes to the small bowel; however, melanoma causing intussusception is rare. We describe a 57-year-old lady with a history of surgically treated malignant melanoma in her nasal cavity who came with an ambiguous intestinal obstruction. Computed tomography reported ileal-ileal intussusception, which was surgically removed via emergency open laparotomy and bowel resection. Intraoperatively the intussusception was 110 cm from the ileo-cecal valve with multiple palpable lymph nodes. Histopathology confirmed the origin as malignant melanoma with lymphovascular invasion. Our literature review found the mean prevalence of intussusception secondary to melanoma was 6.924% (SD ± 5.155). Minimally invasive techniques are reported non-inferior to open laparotomy. We argue that the open technique can provide informed decisions for adequate resection of affected bowel and lymphatic drainage.
所有肠套叠病例中约5%发生于成人,其中高达90%存在解剖学病变,约50%为恶性。恶性黑色素瘤常转移至小肠;然而,导致肠套叠的黑色素瘤罕见。我们报道一名57岁女性,有鼻腔恶性黑色素瘤手术治疗史,因不明原因肠梗阻前来就诊。计算机断层扫描报告为回肠-回肠套叠,通过急诊开放剖腹手术和肠切除进行了手术切除。术中发现套叠距回盲瓣110 cm,有多个可触及的淋巴结。组织病理学证实起源为恶性黑色素瘤伴淋巴管侵犯。我们的文献综述发现,黑色素瘤继发肠套叠的平均患病率为6.924%(标准差±5.155)。据报道,微创技术并不逊色于开放剖腹手术。我们认为开放手术可提供充分切除受累肠段和淋巴引流的明智决策。