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
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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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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 11 | 12 | 23 |
| 2024 Octubre | 64 | 48 | 112 |
| 2024 Septiembre | 69 | 22 | 91 |
| 2024 Agosto | 87 | 54 | 141 |
| 2024 Julio | 79 | 30 | 109 |
| 2024 Junio | 89 | 27 | 116 |
| 2024 Mayo | 64 | 29 | 93 |
| 2024 Abril | 72 | 22 | 94 |
| 2024 Marzo | 57 | 35 | 92 |
| 2024 Febrero | 62 | 27 | 89 |
| 2024 Enero | 45 | 30 | 75 |
| 2023 Diciembre | 49 | 14 | 63 |
| 2023 Noviembre | 52 | 21 | 73 |
| 2023 Octubre | 44 | 26 | 70 |
| 2023 Septiembre | 52 | 34 | 86 |
| 2023 Agosto | 31 | 12 | 43 |
| 2023 Julio | 33 | 33 | 66 |
| 2023 Junio | 36 | 22 | 58 |
| 2023 Mayo | 40 | 25 | 65 |
| 2023 Abril | 38 | 17 | 55 |
| 2023 Marzo | 31 | 21 | 52 |
| 2023 Febrero | 35 | 22 | 57 |
| 2023 Enero | 27 | 27 | 54 |
| 2022 Diciembre | 34 | 35 | 69 |
| 2022 Noviembre | 20 | 23 | 43 |
| 2022 Octubre | 23 | 13 | 36 |
| 2022 Septiembre | 26 | 41 | 67 |
| 2022 Agosto | 22 | 31 | 53 |
| 2022 Julio | 20 | 31 | 51 |
| 2022 Junio | 22 | 21 | 43 |
| 2022 Mayo | 34 | 44 | 78 |
| 2022 Abril | 42 | 36 | 78 |
| 2022 Marzo | 38 | 51 | 89 |
| 2022 Febrero | 26 | 34 | 60 |
| 2022 Enero | 25 | 38 | 63 |
| 2021 Diciembre | 24 | 33 | 57 |
| 2021 Noviembre | 38 | 41 | 79 |
| 2021 Octubre | 35 | 49 | 84 |
| 2021 Septiembre | 25 | 40 | 65 |
| 2021 Agosto | 33 | 29 | 62 |
| 2021 Julio | 32 | 35 | 67 |
| 2021 Junio | 32 | 44 | 76 |
| 2021 Mayo | 32 | 38 | 70 |
| 2021 Abril | 62 | 75 | 137 |
| 2021 Marzo | 49 | 32 | 81 |
| 2021 Febrero | 45 | 34 | 79 |
| 2021 Enero | 22 | 27 | 49 |
| 2020 Diciembre | 23 | 11 | 34 |
| 2020 Noviembre | 17 | 23 | 40 |
| 2020 Octubre | 15 | 16 | 31 |
| 2020 Septiembre | 27 | 9 | 36 |
| 2020 Agosto | 20 | 22 | 42 |
| 2020 Julio | 21 | 13 | 34 |
| 2020 Junio | 27 | 24 | 51 |
| 2020 Mayo | 14 | 20 | 34 |
| 2020 Abril | 36 | 18 | 54 |
| 2020 Marzo | 21 | 22 | 43 |
| 2020 Febrero | 2 | 8 | 10 |
| 2020 Enero | 4 | 3 | 7 |
| 2019 Diciembre | 6 | 1 | 7 |
| 2019 Noviembre | 4 | 0 | 4 |
| 2019 Octubre | 0 | 2 | 2 |
| 2019 Septiembre | 8 | 0 | 8 |
| 2019 Agosto | 4 | 4 | 8 |
| 2019 Julio | 4 | 5 | 9 |
| 2019 Junio | 6 | 8 | 14 |
| 2019 Mayo | 4 | 11 | 15 |
| 2019 Abril | 2 | 11 | 13 |
| 2019 Marzo | 2 | 8 | 10 |
| 2019 Febrero | 2 | 4 | 6 |
| 2019 Enero | 2 | 0 | 2 |
| 2018 Noviembre | 2 | 0 | 2 |
| 2018 Octubre | 1 | 0 | 1 |
| 2018 Septiembre | 3 | 0 | 3 |
| 2018 Marzo | 1 | 0 | 1 |
| 2018 Febrero | 31 | 2 | 33 |
| 2018 Enero | 34 | 9 | 43 |
| 2017 Diciembre | 44 | 10 | 54 |
| 2017 Noviembre | 40 | 7 | 47 |
| 2017 Octubre | 33 | 8 | 41 |
| 2017 Septiembre | 38 | 14 | 52 |
| 2017 Agosto | 59 | 15 | 74 |
| 2017 Julio | 45 | 6 | 51 |
| 2017 Junio | 66 | 29 | 95 |
| 2017 Mayo | 55 | 7 | 62 |
| 2017 Abril | 51 | 13 | 64 |
| 2017 Marzo | 46 | 22 | 68 |
| 2017 Febrero | 24 | 4 | 28 |
| 2017 Enero | 18 | 14 | 32 |
| 2016 Diciembre | 45 | 12 | 57 |
| 2016 Noviembre | 56 | 14 | 70 |
| 2016 Octubre | 51 | 5 | 56 |
| 2016 Septiembre | 38 | 12 | 50 |
| 2016 Agosto | 53 | 5 | 58 |
| 2016 Julio | 34 | 7 | 41 |
| 2016 Junio | 14 | 13 | 27 |
| 2016 Mayo | 7 | 5 | 12 |
| 2016 Abril | 2 | 4 | 6 |
| 2016 Marzo | 10 | 10 | 20 |
| 2016 Febrero | 11 | 10 | 21 |
| 2016 Enero | 4 | 8 | 12 |
| 2015 Diciembre | 12 | 6 | 18 |
| 2015 Noviembre | 11 | 7 | 18 |
| 2015 Octubre | 16 | 4 | 20 |
| 2015 Septiembre | 10 | 8 | 18 |
| 2015 Agosto | 11 | 4 | 15 |
| 2015 Julio | 58 | 6 | 64 |
| 2015 Junio | 49 | 5 | 54 |
| 2015 Mayo | 73 | 16 | 89 |
| 2015 Abril | 51 | 4 | 55 |
| 2015 Marzo | 34 | 13 | 47 |
| 2015 Febrero | 34 | 5 | 39 |
| 2015 Enero | 46 | 17 | 63 |
| 2014 Diciembre | 61 | 8 | 69 |
| 2014 Noviembre | 46 | 12 | 58 |
| 2014 Octubre | 63 | 22 | 85 |
| 2014 Septiembre | 44 | 11 | 55 |
| 2014 Agosto | 66 | 16 | 82 |
| 2014 Julio | 59 | 22 | 81 |
| 2014 Junio | 79 | 18 | 97 |
| 2014 Mayo | 45 | 7 | 52 |
| 2014 Abril | 34 | 1 | 35 |
| 2014 Marzo | 39 | 9 | 48 |
| 2014 Febrero | 34 | 4 | 38 |
| 2014 Enero | 34 | 6 | 40 |
| 2013 Diciembre | 40 | 6 | 46 |
| 2013 Noviembre | 34 | 6 | 40 |
| 2013 Octubre | 27 | 4 | 31 |
| 2013 Septiembre | 21 | 4 | 25 |
| 2013 Agosto | 13 | 6 | 19 |
| 2013 Julio | 16 | 9 | 25 |
| 2013 Junio | 14 | 13 | 27 |
| 2013 Mayo | 14 | 12 | 26 |
| 2013 Abril | 14 | 14 | 28 |
| 2013 Marzo | 16 | 6 | 22 |
| 2013 Febrero | 31 | 5 | 36 |
| 2013 Enero | 39 | 6 | 45 |
| 2012 Diciembre | 28 | 5 | 33 |
| 2012 Octubre | 0 | 1 | 1 |
| 2012 Agosto | 2 | 1 | 3 |
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