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Acute abdomen caused by small bowel perforation due to metastatic malignant melanoma

  • Case Report
  • Published:
Hellenic Journal of Surgery

Abstract

Background-Aim

Malignant melanoma is one of the most common metastatic tumours of the small bowel. Nevertheless, perforation of the small bowel due to these metastatic lesions is an extremely rare condition; only eight cases have been published to date. Reporting such a rare case may provide further data for the management of similar cases.

Case report

A 61-year-old male patient with a known metastatic malignant melanoma (MM) to the liver, lung and adrenal gland who was under treatment with cortisone and monoclonal antibodies (ipilimumab) presented to the emergency department with acute abdomen. Two years earlier, the patient was operated on for a forehead malignant melanoma; he underwent cervical lymph node dissection and was under systemic treatment for distal disease. On admission, the patient was in distress and tachycardic. Clinical examination revealed a painful, rigid abdomen. During the workup, the CT scan showed, apart from the known secondary lesions, free peritoneal air and fluid and at least two further lesions in the jejunum. The patient was taken to theatre and underwent a laparotomy where two lesions were found in the jejunum (one 40 cm and one 60 cm from the Treitz ligament).The distal lesion had caused perforation of the jejunum. There were also suspicious lesions in the segment’s mesentery. We proceeded with resection of the involved part of the small bowel and side-to-side anastomoses. Histology confirmed the lesions to be metastatic MM. The patient had an uneventful postoperative course, and was discharged eight days later in order to be seen by his oncologist.

Conclusion

Despite the fact that perforation of the small bowel due to metastatic melanoma is an extremely rare condition, we should be aware of this probability and it should be considered as one of the working diagnoses in patients with MM who present with an acute abdomen. Prompt surgical resection with intention to cure should be the primary aim of the operating surgeon since long survival can be anticipated.

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Authors and Affiliations

  1. 2nd surgical Department, unit of Surgical Oncology and Breast Unit, “Korgialenio — Benakio”, Athens, Greece

    Sophocles Lanitis, G. Sourtse, G. Sgourakis, K. Karkoulias & C. Karaliotas

  2. Pathology Department, “Korgialenio — Benakio”, Red Cross Athens General Hospital, Athens, Greece

    V. Samaras & C. Barbati

  3. 2nd Surgical department “RED CROSS” Hospital, 1 Athanasaki st, Athens, 11525, Greece

    Sophocles Lanitis

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  1. Sophocles Lanitis
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  2. G. Sourtse
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  3. G. Sgourakis
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  4. K. Karkoulias
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  5. V. Samaras
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  6. C. Barbati
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  7. C. Karaliotas
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Correspondence to Sophocles Lanitis.

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Lanitis, S., Sourtse, G., Sgourakis, G. et al. Acute abdomen caused by small bowel perforation due to metastatic malignant melanoma. Hellenic J Surg 86, 181–185 (2014). https://doi.org/10.1007/s13126-014-0124-y

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  • DOI: https://doi.org/10.1007/s13126-014-0124-y

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