ILEUS CAUSED BY METASTASIS OF CUTANEOUS MALIGNANT MELANOMA : CASE REPORT

Opisana je rijetka pojava metastaze malignog melanoma (MM) u tankom crijevu praćena kliničkom slikom akutnog kirurškog abdomena. Bolesnica u dobi od 42 godine operirana je u našoj ustanovi u travnju 2009. zbog suspektnog nevusa u području desne nadlaktice. Patohistološki radilo se o melanomu promjera 1,5 cm. [Breslow 11mm. Clark IV (T4), mikroskopski broj mitoza 1,4 per mm², ulceracija se ne opisuje]. Uputili smo je na nastavak liječenja u Referentni centar za melanome, Klinička bolnica “Sestre milosrdnice“, Zagreb.Tamo je bolesnica obrađena te je učinjena široka ekscizija (3 cm slobodnog ruba), a nakon pozitivne sentinel biopsije evakuacija sadržaja desne aksile. U nastavku je primila šest doza kemoterapije. Javlja se u našu ustanovu u svibnju 2010. pod kliničkom slikom ileusa tankog crijeva i akutnog kirurškog abdomena. Nakon kraće pripreme istog je dana operirana. Uzrok ileusa bila je metastaza u tankom crijevu. Učinjena je resekcija uz uspostavu kontinuiteta crijeva. Bolesnica je otpuštena na kućnu njegu deset dana nakon zahvata bez komplikacija. Ovaj prikaz bolesnika opisuje u literaturi rjeđe opisivane slučajeve hematogenog i limfogenog rasapa MM otkrivenog pod kliničkom slikom druge kirurške bolesti.In this case report we describe rare metastatic appearance of cutaneous malignant melanoma ( MM ) in small intestine followed by clinical appearance of acute surgical abdomen. A 42-year old women operated in our hospital in April 2009. due to unusual naevus on her right arm. Pathologicaly it was MM grossly 1.5 cm, microscopically Breslow 11 mm, Clark’s level IV (T4), number of mitosis 1.4 per mm², without ulcerations. She was sent to continue treatment at the National Referal Center for Melanoma in KB “S. milosrdnice“ Zagreb, Croatia. A month later wider excision (3 cm free margin) and sentinel lymph node biopsy (SLNB) was made there followed by axillary lymphadenectomy due to positive axillary finding. She received six cycles of chemotherapy. She arrived in our hospital in May 2010, under clinical picture of small intestine ileus and acute surgical abdomen. After preparation she was operated the same day. The cause of ileus was metastasis of MM in the small interstine. We made intestinal resection with termino-terminal anastomosis. The patient was released to home care ten days after operation without any complication. This case report demonstrates rarely described case of MM metastasis in the small intestine found causing ileus