Metastatic melanoma causing small bowel perforation: A case report

Metastatic localization of melanoma often affects the gastrointestinal tract, with reference to the small intestine.

In this work we present the clinical course of a patient affected by a surgically treated melanoma of the right conjunctiva, suddenly manifesting abdominal symptomatology. The abdominal computed tomography scan (CT scan) show evidence of free air into the peritoneal cavity, cholecystitis and brain lesions highly suspicious for metastases. Patient underwent emergency surgery, consisting of ileo-cecal resection, cholecystectomy, with the construction of an ileostomy. The histological examination diagnosed multiple ileal and gallbladder localizations of pigmented epithelial melanoma, and localization.

The treatment of conjunctival melanoma consists in surgical removal. Distant metastases frequently affect the gastrointestinal tract, leading to the necessity to assess patients with abdominal symptoms, in order to avoid emergency scenarios such as the one reported in our study.

Intra-abdominal metastases from melanoma are an event that should not be underestimated, because if detected in time, they can be treated with surgery resulting in a clear improvement in the prognosis. Late diagnosis of intestinal metastases can cause an acute abdomen scenario frequently caused by intestinal obstruction or gastrointestinal bleeding.