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A patient presenting with acute abdomen due to metastatic small bowel melanoma: a case report
© Lianos et al.; licensee BioMed Central Ltd. 2013
Received: 24 January 2013
Accepted: 11 July 2013
Published: 23 August 2013
Malignant tumors of the small bowel are rare. Melanoma of the small intestine is in most cases metastatic from a primary skin lesion. Perforation of small bowel melanoma is an extremely rare entity. To the best of our knowledge this is the fifth case published to date.
We report a rare case of acute abdomen due to perforated metastatic small bowel melanoma in a 38-year-old Caucasian man.
In the majority of cases small bowel melanoma represents metastasis from cutaneous sites. Although rare, the possibility of abdominal metastatic melanoma presenting with the clinical picture of acute abdomen must be always considered by the operating surgeon in patients with a history of primary cutaneous malignant lesion.
Small bowel melanoma is rare and often asymptomatic. Most common symptoms are chronic abdominal pain, bleeding and intestinal obstruction or intussusception. Rarely, a small bowel melanoma occurs with the clinical picture of acute abdomen due to perforation. Correct diagnosis is difficult and most often it can be obtained only after explorative laparotomy. To date, only a few reports of small bowel perforation due to metastatic melanoma have been published[3–5]. We share our experience of successful treatment of such a rare entity.
Small bowel melanoma is a rare entity with difficult diagnosis. The majority of these neoplastic lesions are metastatic from primary skin lesions. It seems that a clear histological distinction between primary small bowel and metastatic intestinal melanoma is very difficult to establish. In most cases, metastatic melanoma of the small bowel is clinically silent. An acute presentation may rarely occur due to intestinal obstruction or intussusception. The clinical picture of acute abdomen due to perforation of small bowel metastatic melanoma is extremely rare. To date only five cases, including our own, of perforation due to melanoma intestinal metastasis have been reported[1, 7, 8].
Preoperative diagnosis of small bowel melanoma is difficult to establish due to the non-specific clinical symptoms. Imaging methods such as capsule endoscopy, CT, magnetic resonance imaging (MRI) and positron emission tomography (PET) scan may generate a suspicion of small bowel melanoma. It has been reported that capsule endoscopy is sensitive in detecting small bowel metastasis, whereas extra-intestinal intra-abdominal involvement might be detected by MRI, CT and PET scan. Definitive diagnosis of small bowel metastasis can be obtained only after explorative laparotomy and bowel resection as an elective method or in an emergency setting, as in our case, and may improve the overall prognosis of the patient[9, 10].
Abdominal metastatic melanoma rarely presents as an acute abdomen. Intestinal metastatic melanoma should be considered in the differential diagnosis of acute abdomen in patients with a history of primary cutaneous melanoma.
Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
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