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The enema study revealed complete obstruction in the advanced part of the ileus tube at the proximal portion to the jejunum.
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The enema study revealed complete obstruction in the advanced part of the ileus tube at the proximal portion of the jejunum (Fig. 1).
Enhanced abdominal computed tomography detected intussusception in the left lower quadrant with a tumor of 5 cm in diameter in the advanced part (white arrow head).
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The oral side of small intestine showed marked dilatation (Fig. 2).
(a), (b): Laparoscopy shows intussusception at the jejunum, 60 cm from the Treitz ligament.
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The surgical findings revealed intussusception 60 cm from the start of the jejunum (Fig. 3a and b).
The tumor is 5 cm x 3 cm in size. The tumor has a blackish appearance and its surface is necrotic.
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(a)-(c) Large and small asymmetric tumors with distinct nucleoli and large tumor cells with melanin deposition were observed. Immunohistochemical staining reveals that the tumor is (d) S-100 (+), (e) HMB-45 (+), (f) Melan-A (+).
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Based on these findings, the tumor was diagnosed as small intestinal metastasis of malignant melanoma (Fig. 5a-e).