CASE 453: SMALL BOWEL MELANOMA, Dr PHAN THANH HẢI, Dr TRẦN MINH ĐÚNG, Dr DƯƠNG NGỌC THÀNH, MEDIC MEDICAL CENTER, TÂM TRÍ GENERAL HOSPITAL, HCMC, VIETNAM

Man 56 yo with acute abdomen pain,  vomitting, and dark stool [melaena]. Clinical examination was oriented to 4th day bowel occlusion.

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Abdomen US scan in emergency  detected  dilated bowel  with  crossed sectional view  presented typical oignon sign  of intussusception  ( US 1,   crossed section;  US 2,  longitudinal  scan.    With linear probe, US 3, CDI examination;  US 4,  multilayer of  intussuscipiens [boudin].

MSCT  with CE of abdomen =   

CT 1: bowel dilatation  due to  bowel obstruction

CT 2 : mass  with  multilayer of small bowel wall.

CT 3 :  intussusception with target sign or pseudokidney sign

CT4 :  sagittal view of the abdomen

Lab test is normal.

Emergency  operation  via laparotomy  with diagnosis  intussusception by small bowel tumor. Surgeon reported that  tumor is black color, intra jejunum, size 5 cm. Microscopic report  with immunohisto chemistry is  malignant melanoma.

UPDATE:

For DISCUSSION  whatever PRIMARY OR SECONDARY MENALOMA?

                       CAREFUL EXAMINATION FULL BODY  DETECTED  ONE SCAR AT THE  LEFT PLANTAR FOOT DUE TO OPERATION 6 YEARS BEFORE AT CANCER CENTER.

BUT PATIENT DID NOT REPORT THIS ISSUE and HAS NOT REPORT FROM THIS OPERATION.

THIS CASE  MAY BE CASE of SECONDARY MELANOMA METASTASIZING TO SMALL BOWEL ( SEE FOTO).

REFERENCE:   SMALL BOWEL MELANOMA