Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0021843 (bowel obstruction)
 9,927 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Intussusception is an infrequent cause of mechanical intestinal obstruction in the adult. We present herein two clinical cases of intussusception with different etiologies. In the first case, the underlying cause was a lipoma, and in the second, it was metastasis from melanoma. In both cases the intussusception was identified through computed tomography and treatment was intestinal resection. Pathologic anatomy provided the definitive diagnosis. Etiology is diverse and it is more common for obstruction to be due to organic lesions that are malignant at the level of the colon and benign at the level of the small bowel. Currently there are more preoperative diagnoses thanks to the advances made in imaging study techniques. Intestinal resection continues to be the treatment of choice in the majority of cases, because of the high percentage of malignant lesions as the underlying cause.
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PMID:[Intussusception in the adult: a rare cause of mechanical obstruction]. 2292 Dec 7

Five per cent of patients presenting with choriocarcinoma develop small bowel metastasis. Tumors of the small bowel are rare and the metastases are generally from lung and breast carcinoma or from melanoma. Clinical presentation is vague and the majority of cases are autopsy findings. The main symptoms are related to the presence of abdominal tumor or hemorrhage, or bowel obstruction or perforation. We present the cases of three patients with small bowel metastasis from choriocarcinoma. A 24-year-old woman with bowel obstruction secondary to intussusception caused by a metastatic choriocarcinoma polypoid mass and two men, one 18 years old and the other 24 years old, with a history of testicular tumor, who presented with gastrointestinal bleeding due to small bowel metastasis from choriocarcinoma, 2 and 10 months after orchiectomy, respectively. Management was endoscopic in one case and surgical in the other two. Two patients died in the early postoperative period and one patient died during the first year of follow-up. Choriocarcinoma metastases are very rare and their main clinical manifestations are hemorrhage and bowel obstruction. Management can be either medical or surgical. The majority of patients with choriocarcinoma respond to chemotherapy but prognosis is worse for those patients presenting with small bowel metastasis.
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PMID:[Jejunal metastasis from choriocarcinoma. A three-case report]. 2292 Dec 6

Melanoma of unknown primary applies to 1-8% of all diagnosed melanomas, whereas primary melanoma of the small intestine is a extremely rare case. One of the melanoma characteristics is its capability of forming metastases in the small intestine which very often are diagnosed during autopsy.We present a case report of diagnosed melanoma of unknown primary, whose first symptom was intestinal obstruction. Before admission to the hospital cause of intestinal obstruction, the patient didn't present any signs and symptoms. All typical localizations of primary melanoma were excluded during diagnostic procedure. Palliative right hemicolectomy and segmental small intestine resection were performed. There were no complications in the postoperative course. On the ninth day the patient was discharged from hospital.Quick identification and radical resection of melanoma metastases in the alimentary tract may improve the survival rate in this group of patients. Resection, even if it is palliative by assumption, is not only the best method of elimination of persistent symptoms but it also gives hope for longer survival.
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PMID:Melanoma of unknown primary as a cause of intestinal obstruction - a case description. 2298 5

Malignant melanoma of the gastrointestinal tract is an uncommon neoplasm that could be primary or metastatic. Small intestine represents the most common site for the metastatic melanoma; however, it could be found anywhere in the gastrointestinal tract. Intussusception is a rare cause of intestinal obstruction in adults compared to children. In 90% of the cases, the underlying cause can be found, and in 65% of the cases, intussusception is caused by the neoplastic process. The majority of the neoplasms are benign, and about 15% are malignant. Metastatic melanoma is one of the most common metastatic malignancies to the gastrointestinal tract; however, the premortem diagnosis is rarely made. Here, we report an uncommon clinical presentation of metastatic melanoma causing intussusception in an 80-year-old man. This diagnosis should be considered in a differential diagnosis in any patient who presents with gastrointestinal symptoms and a history of melanoma.
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PMID:Metastatic melanoma presenting as intussusception in an 80-year-old man: a case report. 2353 93

The vast majority of the cases of intestinal melanomas are metastatic lesions, originating from an occult primary cutaneous or ocular lesion, whereas primary small intestinal melanomas are extremely rare. This is a rare case of primary small intestinal malignant melanoma with intestinal obstruction in a patient with a prior history of rectal cancer resection. The patient was admitted for abdominal pain and obstipation. Following an overall inspection, the patient was subjected to surgical treatment and a small intestinal tumor was removed. The histopathological examination of the lesion revealed a diffuse neoplastic infiltration involving the entire thickness of the intestinal mucosa. The neoplastic cells exhibited marked atypia, pleomorphism and immunoreactivity to S-100, anti-melanoma antibody (HMB-45) and melanocyte/melanoma tumor antigen (Melan-A). The diagnosis of primary small intestinal melanoma was confirmed. The patient underwent an uneventful postoperative recovery and was administered adjuvant therapy. At the 3-month, 6-month and 1-year follow-up, the patient remained alive, with no signs of tumor metastasis and/or recurrence. In this case, the patient was repetitively assessed by abdominal computed tomography (CT) and plain film, confirming that the obstruction was caused by small intestinal melanoma. There was no association between the rectal cancer history and the melanoma. A definitive diagnosis requires detailed clinical, histopathological and immunohistochemical analyses.
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PMID:Intestinal obstruction due to primary intestinal melanoma in a patient with a history of rectal cancer resectioning: A case report. 2464 38

We report here a rare case of metastatic malignant melanoma presenting as ileo-ileal intussusception. A 66-year-old man revealed a past medical history of excision of malignant melanoma, followed by axillary lymph node spread treated with block dissection and radiotherapy. He presented with symptoms of small bowel obstruction and subsequent CT revealed a likely nodular intussusception. Resection confirmed the intussusception and histological analysis confirmed the lead point as metastatic malignant melanoma. It has been reported that up to 5% of those with malignant melanoma will present with bowel metastases before death, yet autopsy studies estimate approximately 60% of those with melanomas have GI metastases. Intussusceptions themselves account for only 1-5% of intestinal obstructions in adults. The magnitude of silent metastases highlights the need to take those with a previous malignant melanoma presenting with GI symptoms seriously as surgery can affect survival.
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PMID:Metastatic malignant melanoma causing ileo-ileal intussusception. 2497 32

Primary malignant melanoma originating in the colon is an extremely rare disease. Herein, we report a case of primary melanoma of the ascending colon. The patient was a 57-year-old male who was admitted to our hospital for persistent abdominal pain and episodes of bloody stool, nausea and vomiting. A computed tomography scan revealed lower intestinal intussusception and enlarged lymph nodes in the abdominal cavity and retroperitoneum. During laparoscopic operation, multiple enlarged lymph nodes were found. Several segments of the proximal small intestine were incarcerated into the distal small intestine, forming an internal hernia and obstruction. The necrotic terminal ileum was invaginated into the ascending cecum. Subsequently, adhesive internal hernia reduction and palliative right hemicolectomy were performed. Pathologic examination of the excised specimen revealed a polypoid mass in the ascending colon. Histological examination showed epithelioid and spindle tumor cells with obvious cytoplasmic melanin deposition. Immunohistochemical staining revealed that the tumor cells were positive for S-100, HMB-45 and vimentin, confirming the diagnosis of melanoma. The patient history and a thorough postoperative investigation excluded the preexistence or coexistence of a primary lesion elsewhere in the skin, anus or oculus or at other sites. Thus, we consider our case to represent an aggressive primary colon melanoma presenting as ileocecal intussusception and intestinal obstruction.
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PMID:Primary colonic melanoma presenting as ileocecal intussusception: case report and literature review. 2507 62

Malignant melanoma is characterized by metastases also to the gastrointestinal tract, especially in the small bowel. The diagnosis is often delayed because unspecific clinical presentation (frequently as chronic iron deficiency anemia, rectal bleeding or intestinal obstruction). We present a case of melanoma of unknown primary site, with clinical presentation of intestinal obstruction. A segmental resection of the ileum was performed including mesentery with lymph nodes. Histology revealed metastatic melanoma from unknown primary. PET and MRI confirmed disseminated disease without brain metastasis.
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PMID:Small bowel intussussception due to metastatic melanoma of unknown primary site. Case report. 2541 93

Visceral metastases from malignant melanoma (stage M1c) confer a very poor prognosis, as documented on the most recent revised version of the TNM/AJCC staging system. Emergency surgery for intra-abdominal complications from the disease is rare. We report on our 5-year single institution experience with surgical management of metastatic melanoma to the viscera in the emergent setting. From 2009 to 2013, 14 patients with metastatic melanoma were admitted emergently due to an acute abdomen. Clinical manifestations encompassed intestinal obstruction and bleeding. Surgical procedures involved multiple enterectomies with primary anastomoses in 8 patients, and one patient underwent splenectomy, one adrenalectomy, one right colectomy, one gastric wedge resection, one gastrojejunal anastomosis, and one transanal debulking, respectively. The 30-day mortality was 7 percent. Median follow-up was 14 months. Median overall survival was 14 months. Median disease free survival was 7.5 months. One-year overall survival was 64.2 percent and 2-year overall survival was 14.2 percent. Emergency surgery for metastatic melanoma to the viscera is rare. Elective curative surgery combined with novel cytotoxic systemic therapies is under investigation in an attempt to grant survival benefit in melanoma patients with visceral disease.
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PMID:Emergency surgery for metastatic melanoma. 2553 Aug 76

Enteric intussusception caused by primary intestinal malignant melanoma is a very rare cause of intestinal obstruction. We herein present a case of a 42-year-old female patient with no prior medical history of malignant melanoma, who was admitted with persistent abdominal pain, nausea, and vomiting. A computed tomography scan revealed an intestinal obstruction due to ileocolic intussusception. An emergency laparoscopy and subsequent laparotomy revealed multiple small solid tumors across the whole small bowel. An oncologic resection was not feasible due to the insufficient length of the remaining small bowel. Only a small segment of ileum, which included the largest tumors causing the intussusception, was resected. The pathologic examination revealed two intestinal malignant melanoma lesions. A systematic clinical examination, endoscopic procedures, and fluorodeoxyglucose positron emission tomography-computed tomography scan all failed to reveal any indication of cutaneous, anal, or retinal melanoma. Hence, the tumor was classified as a primary intestinal malignant melanoma with multiple intestinal metastases. Since a complete oncologic resection of tumors was not possible, in order to prevent future intestinal obstruction, a surgical resection of the largest lesions was performed with palliative intention. The epidemiology, clinical manifestations, diagnosis and management of primary intestinal malignant melanoma, and intestinal intussusception in adults are discussed along with a review of the current literature.
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PMID:Recurrent intussusception as initial manifestation of primary intestinal melanoma: Case report and literature review. 2578 Mar 13


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