Case and Research Letters
Intussusception in an Adult Secondary to Metastasis of Cutaneous Melanoma
Invaginación intestinal en el adulto secundaria a metástasis de melanoma cutáneo
L. Muiños-Ruano
, A. Llaneza-Folgueras, A. Rizzo-Ramos, C. Menéndez-Dizy
Corresponding author
Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
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Muiños-Ruano, A. Llaneza-Folgueras, A. Rizzo-Ramos, C. Menéndez-Dizy" "autores" => array:4 [ 0 => array:4 [ "nombre" => "L." "apellidos" => "Muiños-Ruano" "email" => array:1 [ 0 => "lauramruano@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Llaneza-Folgueras" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Rizzo-Ramos" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Menéndez-Dizy" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Invaginación intestinal en el adulto secundaria a metástasis de melanoma cutáneo" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 557 "Ancho" => 1401 "Tamanyo" => 140194 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Surgical specimen.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Intussusception is the infolding of one portion of the bowel within another and is the most common cause of intestinal obstruction in early childhood. Adult intussusception accounts for fewer than 5% of all intussusceptions and only 1% of all bowel obstructions.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The symptoms are those of partial or complete mechanical bowel obstruction, and in partial cases, the course can be intermittent or chronic.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Cutaneous melanoma is rarely diagnosed as the etiology of intussusception in adults and is therefore not usually suspected when obstructive symptoms appear.</p><p id="par0015" class="elsevierStylePara elsevierViewall">We describe a 47-year-old woman diagnosed with superficial spreading cutaneous melanoma on the left shoulder. The lesion showed no ulceration and had a diameter of 8<span class="elsevierStyleHsp" style=""></span>mm, a Breslow depth of 4<span class="elsevierStyleHsp" style=""></span>mm, and a Clark level of <span class="elsevierStyleSmallCaps">III</span>. Following surgical resection and the detection of positive sentinel lymph nodes, axillary lymphadenectomy was performed; histology was negative. The patient received adjuvant therapy with interferon, but experienced recurrence in the left supraclavicular lymph nodes 2 years later. After 3 doses of fotemustine, the left supraclavicular lymph nodes were resected en bloc; 3 of these nodes were positive. The patient received radiation therapy to the surgical site.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Some months later, the patient was urgently referred to the general surgery department for colicky abdominal pain, digestive intolerance, loose stools, and macrocytic anemia. Computed tomography (CT) revealed bowel obstruction (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), and probable intestinal metastasis of the cutaneous melanoma was suspected.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">During surgery, intussusception was observed and the head was found to consist of a bluish mass; the intussuscepted jejunum (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) and all visible blue lymph nodes were resected en bloc.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Macroscopically, the small bowel specimen was 39<span class="elsevierStyleHsp" style=""></span>cm in length, with intussusception at 14.5<span class="elsevierStyleHsp" style=""></span>cm caused by a blackish tumor of 4<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>7<span class="elsevierStyleHsp" style=""></span>cm that occluded the entire lumen. The microscopic report described melanoma infiltrating the muscularis propria; 5 of the 17 lymph nodes isolated in the mesocolon were positive. The resection borders were free of tumor.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The postoperative course was unremarkable, and the patient was referred to the oncology department for follow-up.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Intussusception in an adult is a potentially serious condition that is usually secondary to an intestinal wall lesion: benign or malignant tumor, inflammatory lesion (appendicitis, Meckel diverticulum), or even a foreign body in the small bowel. Therefore, it almost always occurs in the ileocecal area, but is less common in the jejunojejunal or ileocecocolic areas.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The preoperative diagnostic techniques of choice are CT and ultrasound. Recent studies recommend that patients with cutaneous melanoma who develop gastrointestinal symptoms should undergo contrast-enhanced studies (enteroclysis, opaque enema, etc.), complemented by CT, depending on the result.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The definitive diagnosis is established after surgery and histology. In general, immunohistochemical staining of the material obtained is essential for the diagnosis of metastatic tumors.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Bowel resection is the surgical technique of choice because of its increased safety and adherence to oncologic principles. The intussusception should only be reduced first when there is a potential benefit to the patient.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Other groups advocate conservative treatment when the etiology of intussusception is not clear; such treatment will depend on the type of intussusception and on the clinical signs and symptoms and should always be accompanied by follow-up.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Intussusception can now be diagnosed and treated laparoscopically, although in cases of complete bowel obstruction, the technique is complicated by the distension of the intestinal loops and the fragility of the intestinal wall.</p><p id="par0070" class="elsevierStylePara elsevierViewall">The head of the intussusception is often a malignant lesion (52% of cases),<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and there are cases where this lesion is a metastasis of a cutaneous melanoma.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">The presence of an early complication caused by bowel obstruction, investigated by appropriate diagnostic methods, can lead to the early diagnosis of metastatic spread of a melanoma,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> as in the case we describe.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Once metastasis is diagnosed, surgery is the only option for treating complications of bowel obstruction due to melanoma (e.g. chronic anemia, episodes of partial bowel obstruction) and improving survival rates and quality of life in these patients.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Muiños-Ruano L, et al. Invaginación intestinal en el adulto secundaria a metástasis de melanomsa cutáneo. Actas Dermosifiliogr.2012:441-2.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 536 "Ancho" => 1401 "Tamanyo" => 113884 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Computed tomography. A, Small-bowel dilatation consistent with intestinal obstruction. B, Jejunum. Image of multiple concentric rings with a central lesion (bulls-eye image).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 557 "Ancho" => 1401 "Tamanyo" => 140194 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Surgical specimen.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adult intussusception" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E.M. Haas" 1 => "E.L. Etter" 2 => "S. Ellis" 3 => "T.V. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 13 | 12 | 25 |
| 2024 October | 64 | 48 | 112 |
| 2024 September | 69 | 22 | 91 |
| 2024 August | 87 | 54 | 141 |
| 2024 July | 79 | 30 | 109 |
| 2024 June | 89 | 27 | 116 |
| 2024 May | 64 | 29 | 93 |
| 2024 April | 72 | 22 | 94 |
| 2024 March | 57 | 35 | 92 |
| 2024 February | 62 | 27 | 89 |
| 2024 January | 45 | 30 | 75 |
| 2023 December | 49 | 14 | 63 |
| 2023 November | 52 | 21 | 73 |
| 2023 October | 44 | 26 | 70 |
| 2023 September | 52 | 34 | 86 |
| 2023 August | 31 | 12 | 43 |
| 2023 July | 33 | 33 | 66 |
| 2023 June | 36 | 22 | 58 |
| 2023 May | 40 | 25 | 65 |
| 2023 April | 38 | 17 | 55 |
| 2023 March | 31 | 21 | 52 |
| 2023 February | 35 | 22 | 57 |
| 2023 January | 27 | 27 | 54 |
| 2022 December | 34 | 35 | 69 |
| 2022 November | 20 | 23 | 43 |
| 2022 October | 23 | 13 | 36 |
| 2022 September | 26 | 41 | 67 |
| 2022 August | 22 | 31 | 53 |
| 2022 July | 20 | 31 | 51 |
| 2022 June | 22 | 21 | 43 |
| 2022 May | 34 | 44 | 78 |
| 2022 April | 42 | 36 | 78 |
| 2022 March | 38 | 51 | 89 |
| 2022 February | 26 | 34 | 60 |
| 2022 January | 25 | 38 | 63 |
| 2021 December | 24 | 33 | 57 |
| 2021 November | 38 | 41 | 79 |
| 2021 October | 35 | 49 | 84 |
| 2021 September | 25 | 40 | 65 |
| 2021 August | 33 | 29 | 62 |
| 2021 July | 32 | 35 | 67 |
| 2021 June | 32 | 44 | 76 |
| 2021 May | 32 | 38 | 70 |
| 2021 April | 62 | 75 | 137 |
| 2021 March | 49 | 32 | 81 |
| 2021 February | 45 | 34 | 79 |
| 2021 January | 22 | 27 | 49 |
| 2020 December | 23 | 11 | 34 |
| 2020 November | 17 | 23 | 40 |
| 2020 October | 15 | 16 | 31 |
| 2020 September | 27 | 9 | 36 |
| 2020 August | 20 | 22 | 42 |
| 2020 July | 21 | 13 | 34 |
| 2020 June | 27 | 24 | 51 |
| 2020 May | 14 | 20 | 34 |
| 2020 April | 36 | 18 | 54 |
| 2020 March | 21 | 22 | 43 |
| 2020 February | 2 | 8 | 10 |
| 2020 January | 4 | 3 | 7 |
| 2019 December | 6 | 1 | 7 |
| 2019 November | 4 | 0 | 4 |
| 2019 October | 0 | 2 | 2 |
| 2019 September | 8 | 0 | 8 |
| 2019 August | 4 | 4 | 8 |
| 2019 July | 4 | 5 | 9 |
| 2019 June | 6 | 8 | 14 |
| 2019 May | 4 | 11 | 15 |
| 2019 April | 2 | 11 | 13 |
| 2019 March | 2 | 8 | 10 |
| 2019 February | 2 | 4 | 6 |
| 2019 January | 2 | 0 | 2 |
| 2018 November | 2 | 0 | 2 |
| 2018 October | 1 | 0 | 1 |
| 2018 September | 3 | 0 | 3 |
| 2018 March | 1 | 0 | 1 |
| 2018 February | 31 | 2 | 33 |
| 2018 January | 34 | 9 | 43 |
| 2017 December | 44 | 10 | 54 |
| 2017 November | 40 | 7 | 47 |
| 2017 October | 33 | 8 | 41 |
| 2017 September | 38 | 14 | 52 |
| 2017 August | 59 | 15 | 74 |
| 2017 July | 45 | 6 | 51 |
| 2017 June | 66 | 29 | 95 |
| 2017 May | 55 | 7 | 62 |
| 2017 April | 51 | 13 | 64 |
| 2017 March | 46 | 22 | 68 |
| 2017 February | 24 | 4 | 28 |
| 2017 January | 18 | 14 | 32 |
| 2016 December | 45 | 12 | 57 |
| 2016 November | 56 | 14 | 70 |
| 2016 October | 51 | 5 | 56 |
| 2016 September | 38 | 12 | 50 |
| 2016 August | 53 | 5 | 58 |
| 2016 July | 34 | 7 | 41 |
| 2016 June | 14 | 13 | 27 |
| 2016 May | 7 | 5 | 12 |
| 2016 April | 2 | 4 | 6 |
| 2016 March | 10 | 10 | 20 |
| 2016 February | 11 | 10 | 21 |
| 2016 January | 4 | 8 | 12 |
| 2015 December | 12 | 6 | 18 |
| 2015 November | 11 | 7 | 18 |
| 2015 October | 16 | 4 | 20 |
| 2015 September | 10 | 8 | 18 |
| 2015 August | 11 | 4 | 15 |
| 2015 July | 58 | 6 | 64 |
| 2015 June | 49 | 5 | 54 |
| 2015 May | 73 | 16 | 89 |
| 2015 April | 51 | 4 | 55 |
| 2015 March | 34 | 13 | 47 |
| 2015 February | 34 | 5 | 39 |
| 2015 January | 46 | 17 | 63 |
| 2014 December | 61 | 8 | 69 |
| 2014 November | 46 | 12 | 58 |
| 2014 October | 63 | 22 | 85 |
| 2014 September | 44 | 11 | 55 |
| 2014 August | 66 | 16 | 82 |
| 2014 July | 59 | 22 | 81 |
| 2014 June | 79 | 18 | 97 |
| 2014 May | 45 | 7 | 52 |
| 2014 April | 34 | 1 | 35 |
| 2014 March | 39 | 9 | 48 |
| 2014 February | 34 | 4 | 38 |
| 2014 January | 34 | 6 | 40 |
| 2013 December | 40 | 6 | 46 |
| 2013 November | 34 | 6 | 40 |
| 2013 October | 27 | 4 | 31 |
| 2013 September | 21 | 4 | 25 |
| 2013 August | 13 | 6 | 19 |
| 2013 July | 16 | 9 | 25 |
| 2013 June | 14 | 13 | 27 |
| 2013 May | 14 | 12 | 26 |
| 2013 April | 14 | 14 | 28 |
| 2013 March | 16 | 6 | 22 |
| 2013 February | 31 | 5 | 36 |
| 2013 January | 39 | 6 | 45 |
| 2012 December | 28 | 5 | 33 |
| 2012 October | 0 | 1 | 1 |
| 2012 August | 2 | 1 | 3 |
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