Abdominal Pain and Vomiting in 76 M with Melanoma • Xray of the Week
A 76 yo male with a history of malignant melanoma presented with blood in the stool. Twenty days later he returned with vomiting. CT scan of abdomen and pelvis was performed.
Day 1: Axial and coronal images showing masses in the small bowel due to melanoma metastases.
20 days later: Axial and coronal images showing dilated small bowel indicating obstruction. There is also also a target sign due to intussusception. The lead point is a metastatic focus of melanoma. Note also the enhancing metastatic masses in the gallbladder.
Day 1: Larger coronal image showing mass in the small bowel due to melanoma metastases (blue arrow). Note also the enhancing metastatic masses in the gallbladder. (red arrow)
20 days later: Coronal image showing dilated small bowel indicating obstruction. There is also a target sign due to intussusception. (green arrow) The lead point is a metastatic focus of melanoma.
In children intussusception is usually idiopathic; whereas, with adult intussusception a lead point is present in greater than 90% of cases. Melanoma metastases to the small bowel is seen in approximately 60% of patients with malignant melanoma. However, these only become symptomatic in less than 5% of patients. Symptoms may include abdominal pain, intestinal obstruction with vomiting, weight loss or anemia. Rarely, masses from metastatic melanoma within the small bowel can cause intussusception. Treatment is surgical, usually requiring resection of the mass and the adjacent segment of bowel.
Related Global Rad CME case: Ileo-colic intussusception in a 6 month old
1. Frederico Ferreira de SouzaI; Felipe Ferreira de SouzaII, et al. Metastatic melanoma causing small bowel intussusception: diagnosis by 18F-FDG PET/CT. Radiol Bras vol.42 no.5 São Paulo Sept./Oct. 2009
2. P Floros, B Rai; Small Bowel Intussusception Due To Malignant Melanoma of Unknown Primary With Adrenal Metastasis At Presentation. The Internet Journal of Surgery. Volume 26. Number 2. http://ispub.com/IJS/26/2/11652
3. Ahmed Guirata, Gadiel Lisciaa; Acute ileo-ileal intussusception due to intestinal metastatic melanoma. Polish Annals of Medicine. Volume 22, Issue 1, June 2015, Pages 41–44
4. Fernando A. Alvarez, Matías Nicolás; Ileocolic intussusception due to intestinal metastatic melanoma. Case report and review of the literature. Int J Surg Case Rep. 2011; 2(6): 118–121
Kevin Rice, MD is a radiologist with Renaissance Imaging Medical Associates. Dr. Rice has made several media appearances as part of his ongoing commitment to public education. Dr. Rice's passion for state of the art radiology and teaching includes acting as a guest lecturer at UCLA. In 2015 Dr. Rice and Natalie Rice founded Global Radiology CME to provide innovative radiology education at exciting international destinations, with the world's foremost authorities in their field. In 2016, Dr. Rice was nominated and became a semifinalist for a "Minnie" award for the Most Effective Radiology Educator.
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