case_images: PMC11756941_01
case_images: PMC11756941_02
case_images: Ileoileal intussusception secondary to intestinal metastasis on abdominal computed tomography (CT). In light of the suspicion of progression of the metastatic melanoma disease, a whole-body CT scan was conducted, which confirmed progression. Coronal (a) and axial (b) slices of abdominal CT revealed multiple nodules and focal parietal thickening of the intestinal loops (arrowheads in a and b) suggestive of intramural implants. Months after that last CT, the patient presented at the emergency department with obstructive symptoms, so a second abdominopelvic CT scan was conducted. Coronal (c) and axial (d) slices showed distension of jejunal and ileal loops up to a caliber of 5 cm (asterisks in c and d) proximal to the insertion of a 10-cm-long segment of the distal ileum into the contiguous ileal loop (arrows in c and d), at the site of one of the enteric metastatic implants described in the previous CT. This was interpreted as intestinal obstruction secondary to ileoileal intussusception, probably in relation to intestinal implants of metastatic melanoma.
case_images: CRIS2025-5556332.001.jpg
case_images: PMC11756941_02_CRIS2025-5556332.001.jpg
case_images: fig1
case_images: The images showed marked distension of the jejunum and ileum proximally to a sudden change in caliber due to a telescoping of distal ileal loops, which was topographically aligned with one of the enteric implants observed in a previous abdominal CT scan conducted 9 months earlier (Figure 1).
case_images: PMC11756941_03
case_images: Laparotomy with ileotomy in intramural melanoma metastases. After identifying intestinal obstruction secondary to intussusception on computed tomography (CT), the patient was considered for palliative surgery. During laparotomy, a 10-cm ileoileal intussusception (arrow in a) with retrograde distension of intestinal loops was observed. After the intussusception was reduced, two nodular lesions were observed inside the terminal ileum (arrowheads in b), which had led to the telescoping of ileal loops. Macroscopic examination of the surgical ileotomy specimen identified two solid nodular exophytic tumors in the resected ileal segment (arrowheads in c). Microscopic examination (d and e, hematoxylin and eosin staining) revealed the infiltration of the ileal wall by two tumors with a solid pattern and areas of necrosis, cells of epithelioid appearance with broad eosinophilic cytoplasm, atypical nuclei and prominent nucleoli, and the presence of mitotic figures. The immunohistochemical examination was positive for Melan A (f) and SOX10 (g), all of which was conclusive for intramural melanoma metastases.
case_images: CRIS2025-5556332.002.jpg
case_images: PMC11756941_03_CRIS2025-5556332.002.jpg
case_images: fig2
case_images: During laparoscopic surgery, a 10-cm intussusception was identified in the distal ileum (Figure 2a), accompanied by retrograde intestinal distension. Following surgical reduction, two nodular lesions were identified in the terminal ileum (Figure 2b), which caused the insertion of one intestinal segment into the adjoining loop. Macroscopic examination of the surgical specimen identified two solid nodular exophytic tumors in the resected ileal segment (Figure 2c), one of them extending to the serosa. Microscopic examination (Figure 2d-g) revealed their neoplastic nature and positivity to Melan A and SOX10 in the immunohistochemical examination, all of which was conclusive for intramural intestinal metastases of melanoma.