A clinical case of small intestinal intussusception caused by metastatic melanoma

Abstract

Intestinal obstruction is observed in about 9.0 % of patients with acute surgical pathology of the abdominal cavity. The disease occurs at any age, but more often between 25–50 years. Mixed intestinal obstruction is only 3–7 %. The most common form of mixed intestinal obstruction is intestinal invasion. The most common cause of intussusception in adults is an intestinal tumor. Early diagnosis and the optimal amount of surgical treatment are the main components of successful treatment of the patient. Aim: to familiarize practitioners with a rare case of intestinal obstruction in adults and its management strategies in a surgical hospital. Materials and methods. The patient was treated in the surgical department of the Communal Non-Profit Enterprise “City Hospital No. 7” Zaporizhzhia City Consul. The patient underwent preoperative preparation and surgical intervention. Results. The patient underwent an emergency median laparotomy under total intravenous anesthesia with artificial lung ventilation. During the examination of the abdominal cavity, multiple distended loops of the small intestine were visualized. During the revision, at a distance of 1.5 meters from the ligament of Treitz, a volumetric formation of the small intestine of dense-elastic consistency, represented by small-intestinal invasion, up to 10 cm long, was detected. The proximal sections of the small intestine are distended, light purple in color. The sections of the small intestine that were distal to the site of invasion were inflamed. Manual disinvagination of the small intestine was performed. The visual examination showed that the intestine was viable. There was a tumor was found on the antrumeral margin, measuring 1.8 × 2.5 cm, dense in consistency, finely tuberculated, dark purple heterogeneous in color, infiltrating and deforming the wall of the small intestine. Resection of the invaded area of the small intestine with the tumor was performed with the imposition of a small-small intestinal anastomosis “side to side” with two-row nylon sutures. Conclusions. In this clinical case, it was possible to establish the final diagnosis and determine further surgical strategy only intraoperatively. Only early diagnosis of melanoma will allow avoiding the complications identified in this patient.