PMC10157394_01
Timeline of diagnostics and treatment of melanoma and subsequent severe colitis resulting in surgery. The asterisk reflects when the patient first noticed colitis symptoms. The PET, positron emission tomography; ED, Emergency department.
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Repeat PET scan 6 months after diagnosis demonstrated hypermetabolic foci of uptake in the inguinal and pubic regions; however, this was correlated to areas of hidradenitis-related inflammation ( Figure 1 ). He also recalls that the timing of the colitis was "nearly instantaneous" with the initiation of combination Ipilimumab and Nivolumab therapy (indicated on  Figure 1  with an asterisk).
Cross-sectional imaging of a 37-year-old M with Stage IV in-transit melanoma receiving immune checkpoint inhibitor therapy who presents with severe abdominal pain. A characteristic target-sign for intussusception is appreciated in cecum (triangle) and can be seen on the axial, coronal, and sagittal views.
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Cross-sectional imaging at the time demonstrated ileocecal intussusception and raised concerns for a cecal mass ( Figure 2 ) suggesting neoplastic disease.
Photo of surgical resection specimen with terminal ileum, ileocecal valve, cecum, and ascending colon. The triangle denotes the location of the intussusception that appears to originate at the level of the coalescence of the tinea at the base of the cecum. Final pathology demonstrated advanced colitis and cecal ischemia.
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Specifically, the cecum appeared to invaginate from the coalescence of the tinea (where the appendiceal orifice would have been; however, the patient had a laparoscopic appendectomy years prior) and had intussuscepted antegrade along the ascending colon ( Figure 3 ).