Ileo-ileal intussusception secondary to malignant metastatic melanoma: a case report


  • Rahul Menon Department of General Surgery, Ipswich Hospital, Ipswich, QLD, Australia
  • Ramesh Iyer Department of General Surgery, Ipswich Hospital, Ipswich, QLD, Australia



Malignant melanoma, Emergency surgery, Oncological surgery, Immunotherapy, Chemotherapy


Intestinal intussusception in adults is a rare manifestation and almost certainly represents a pathological lead point such as a neoplasm. We present such a case of ileo-ileal intussusception with an extraluminal deposit of metastatic melanoma (MM) acting as a lead point. A 48-year-old gentleman presented with small bowel obstruction secondary to ileo-ileal intussusception. His past medical history included an advanced cutaneous melanoma awaiting work-up. An emergency laparotomy with small-bowel resection and primary anastomosis was performed. Histopathological analysis confirmed metastatic melanoma and systemic therapy was commenced. Melanoma commonly metastases to the small intestine, they often present with intussusception and small bowel obstruction or bleeding. The risk factors for metastatic spread include superficial spreading melanoma, a Clark level of III or IV, Breslow thickness above 1mm, regression, ulceration, and high mitotic rate. Diagnosis is made radiologically with CT, endoscopy, contrast studies or nuclear medicine. Emergency operative management is indicated to relieve the obstruction and definitive therapy is indicated. Malignant melanoma with distal metastases is considered a stage IV disease and such patients are subject to systemic therapy including surgical resection, chemotherapy, immunotherapy, or a combination of all three. Ileo-ileal intussusception with MM as a lead point is a very rare presentation in antemortem patients. A CT scan is the investigatory modality of choice and emergency surgery is indicated to relieve obstruction and obtain histology. Prognosis is poor but novel immunotherapy agents herald opportunities even in palliative patients.


Panagiotou I, Brountzos EN, Bafaloukos D, Stoupis C, Brestas P, Kelekis DA. Malignant melanoma metastatic to the gastrointestinal tract. Melanoma Res. 2002;12(2):169-73.

Schuchter LM, Green R, Fraker D. Primary and metastatic diseases in malignant melanoma of the gastrointestinal tract. Curr Opin Oncol. 2000;12(2):181-5.

Marinis A, Yiallourou A, Samanides L, Dafnios N, Anastasopoulos G, Vassiliou I, Theodosopoulos T. Intussusception of the bowel in adults: a review. World J Gastroenterol. 2009;15(4):407-11.

Kumano K, Enomoto T, Kitaguchi D, Owada Y, Ohara Y, Oda T. Intussusception induced by gastrointestinal metastasis of malignant melanoma: A case report. Int J Surg Case Rep. 2020;71:102-6.

Dasgupta TK, Brasfield RD. Metastatic melanoma of the gastrointestinal tract. Arch Surg. 1964;88:969-73.

Liang KV, Sanderson SO, Nowakowski GS, Arora AS. Metastatic malignant melanoma of the gastrointestinal tract. Mayo Clinic Proceedings: Elsevier; 2006: 511-516.

Damian DL, Fulham MJ, Thompson E, Thompson JF. Positron emission tomography in the detection and management of metastatic melanoma. Melanoma Res. 1996;6(4):325-9.

Ciftci F. Diagnosis and treatment of intestinal intussusception in adults: a rare experience for surgeons. Int J Clin Exp Med. 2015;8(6):10001-5.

Honjo H, Mike M, Kusanagi H, Kano N. Adult intussusception: a retrospective review. World J Surg. 2015;39(1):134-8.

Balch CM, Gershenwald JE, Soong SJ, Thompson JF, Atkins MB, Byrd DR, et al. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol. 2009;27(36):6199-206.

Wilson MA, Schuchter LM. Chemotherapy for Melanoma. Cancer Treat Res. 2016;167:209-29.






Case Reports