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1. Objective. Asymptomatic intussusception has increasingly been observed incidentally in adults undergoing CT scan and may represent a benign, transient finding. However, in patients with a history of malignancy, intussusception raises the possibility of a lead point requiring excision to prevent future complications. The aim of the present study was to determine the need for operative intervention for asymptomatic intussusception in patients with a history of melanoma.
2. Design. Case series.
3. Setting. Yale Cancer Center, New Haven, CT.
4. Patients. Melanoma patients with intussusception seen on imaging who lacked acute symptoms of obstruction were included in the series. Patients with acute symptoms requiring urgent intervention were excluded.
5. Interventions. None.
6. Main Outcome Measures. Melanoma stage, length and location of intussusception observed on CT, clinical interventions undertaken, presence of intussusception and an associated mass at time of surgery, clinical outcome.
7. Results. Intussusception was detected on CT scan in five melanoma patients without acute abdominal symptoms. Three patients were asymptomatic, while two patients complained of chronic intermittent abdominal symptoms. One patient had a prior history of small bowel intussusception with removal of an associated mass. Conservative management was employed in one case, and the patient remained symptom free at four months follow-up, with resolution of intussusception on CT. Of four patients treated surgically, three demonstrated extensive bowel metastases with one or more areas of intussusception, while no intestinal pathology could be identified in the remaining patient.
8. Conclusions. Bowel metastases were present in a high proportion of patients with intussusception and a history of melanoma. Thus, operative intervention is appropriate for all melanoma patients with intussusception, even in the absence of abdominal symptoms.