INTESTINAL INTUSSUSCEPTION BY META-STATIC MELANOMA IN SMALL INTESTINE -CASE REPORT

Case Presentation: Female patient, black, 45 years old, diagnosed with melanoma in Jul/17, primary lesion in palatine tonsil, stage IV with lymph node and pulmonary metastasis. She had Dacarbazine chemotherapy until Jan/18. It evolved with disease progression. Reintroduced Dacarbazine until Jun/19 with partial response. Hospitalized in Jul/19 with bowel obstruction and tomography compatible with intestinal intussusception. The patient underwent surgical treatment and an intraluminal jejunal tumor lesion at 20 cm from the Treitz angle was identified, causing jejuno-jejunal intussusception. Segmental enterectomy with anastomosis was performed. Anatomopathological report confirmed metastatic melanoma with free surgical margins. Postoperative period with good clinical evolution and no complications. Proceed oncological control. Discussion: Melanoma is an uncommon skin cancer, representing 3% of all malignant skin neoplasms. Despite its low incidence, it is reponsable for about 2/3 of deaths in this group. It may behave aggressively with distant metastasis, including the gastrointestinal tract (TGI), in which case, the most common location is at small bowel. The symptomatology is indolent, with nonspecific abdominal pain and anemia. The most common complications are bleeding, obstruction, perforation and intestinal intussusception. In cases of complications, surgical treatment is indicated and should preferably involve resection of the metastatic lesion. Uncomplicated visceral metastasis are treated systemically, except when TGI is the only site of metastasis, and complete resection of the lesions is possible. Final Comments: TGI is a common site of metastasis in cases of disseminated melanoma. Autopsy studies revealed an incidence of about 60% of intestinal metastasis in patients who died of disseminated melanoma, but in clinical practice about 5% of patients with disseminated disease have this type of lesion. Establishing preoperative diagnosis of small bowel metastasis is difficult due to the non-specificity of symptoms and limitations of diagnostic methods. The definitive diagnosis is obtained after surgical exploration and resection of the lesion. With the present report we emphasize that melanoma patients with persistent gastrointestinal complaints or acute abdomen should have as a clinical suspicion gastrointestinal metastasis, so the necessary propaedeutics is established and the appropriate cancer treatment performed.