An unusual case of intestinal obstruction.

A 66 year-old man presented to emergency room complainingof abdominal pain, vomiting, and inactive bowel, and was admit-ted to hospital with a diagnosis of acute bowel obstruction. Hehad no history of previous abdominal surgery however, three yearsprior he had undergone excision of a thoracic skin melanoma, withright axillary lymph node dissection. The procedure was followedby 12 months of interferon therapy. Recent scheduled laboratoryfollow-up revealed an increase in inflammatory markers and mildanaemia. Abdominal X-ray showed diffusion of intestinal air–fluidlevels and computed tomography scans suggested volvulus of thesmall bowel (Fig. 1).At exploratory laparoscopy a duplication of the terminalileum was found, and resection of 30 cm of ileum and pri-mary anastomosis was performed. Pathology confirmed the cystic∗Corresponding author at: Department of Surgery, Torre 8 I Piano, Policlinico TorVergata, Viale Oxford 81, 00133 Rome, Italy. Tel.: +39 0620903596;fax: +39 0620902926.E-mail address: sigisica@gmail.com (G.S. Sica).Fig. 2.duplication of the terminal ileum, and a large polyp measuring8.5 cm × 5 cm × 6 cm with a central green necrotic area (Fig. 2)was found on the mucosal surface. Immunohistochemical analy-sis revealed immunoreactivity for Melan A, S 100 and Vimentin,thereby confirming the presence of metastatic melanoma.Roughly 80% of duplications of the intestine are found in infants,with the ileum as the most frequently affected site [1]. In adulthood,surgical resection should be considered in symptomatic patients.Intestinal metastases from primary melanoma are infrequent butcan cause bowel obstruction, and relationship with the intestinalduplication is unknown.Reference[1] Ladd WE. Surgical diseases of the alimentary tract in infants. The New EnglandJournal of Medicine 1936;215:705–8.