P4176 - A Pigmented Pull: A Case of Late Metastatic Melanoma Presenting as Ileocolic Intussusception

Lesley- Ann McCook, MD¹, Amit Sah, MD¹, Elizabeth Zakka, MD², Kayode Olowe, MD^3
1University of Miami, Atlantis, FL; ²University of Miami at JFK Medical Center, Lantana, FL; ³HCA Healthcare, Atlantis, FL

Introduction: Intussusception refers to the telescoping of the gastrointestinal(GI) tract into the lumen of an adjacent segment. This condition is uncommon in the adult population, representing ~ 5% of all cases of intussusception, however when present, is most often tumor related. Though malignant melanoma (MM) located in the bowel is a rare entity, it the most common malignancy to metastasize to the GI tract. We present a case of late metastatic MM in an 83-year-old male as the underlying etiology of his intussusception.

Case Description/Methods: An 83-year-old male with a history of superficial spreading melanoma diagnosed & excised 12 years prior, presented for a 4- day history of worsening abdominal pain associated with nausea and intractable bilious non-bloody emesis. His vital signs on arrival, excluding a mild tachycardia, were within normal limits. His physical examination revealed conjunctival pallor and a globally distended tympanitic abdomen with tenderness to palpation without rebound or guarding. Initial blood investigations were notable for hyponatremia (133 mmol/L), hypokalemia(2.9 mmol/L), acute kidney injury( Creatinine 1.14 mg/dl) and microcytic anemia ( Hemoglobin 11.9g/dl). CT abdomen and pelvis demonstrated dilated loops of small bowel and a large ileal colonic intussusception. Small bowel series confirmed high-grade small bowel obstruction. He received supportive management with intravenous fluids, antiemetics and analgesia. General surgery was consulted, and he underwent a diagnostic laparoscopy with right hemicolectomy & ileocolic anastomosis. Surgical histology confirmed submucosal and intramural malignant melanoma with mucosal ulceration consistent with clinical intussusception. Considering the patient's history of melanoma and biopsy findings, the diagnosis of metastatic malignant melanoma to the ileum was made.

Discussion: MM has an affinity to spread to the small bowel. Primary cutaneous melanoma lesions may precede gastrointestinal metastasis by many years and due to its nonspecific symptoms, may be difficult to diagnose. Through this case, we aim to expose the rare occurrence of late metastatic melanoma to the ileum occurring 12 years after the initial skin diagnosis was made. Timely diagnosis is vital for favorable evaluation of patients as possible surgical candidates. For this reason, physicians should have a high degree of suspicion when evaluating any patient with a history malignant melanoma presenting with new GI symptoms.


Disclosures:


Lesley- Ann McCook, MD¹, Amit Sah, MD¹, Elizabeth Zakka, MD², Kayode Olowe, MD³. P4176 - A Pigmented Pull: A Case of Late Metastatic Melanoma Presenting as Ileocolic Intussusception, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.