Small Bowel Intussusception and Anorectal Tumor Caused By Melanoma Malignant

Metastasis
JA Uwuratuw, Mappincara
Digestive Surgery Division, Department Of Surgery Hasanuddin Faculty Of Medicine
Abstract :
Background : Incidence of small bowel Metastasis of Melanoma Malignant (MM) is 1% - 2%. Symptoms
are pain, constipation, obstruction, perforation, bleeding and anemia. MM in colon is rarely, only 12 cases
have been reported by recent literature. While Anorectal Melanoma Malignant is very rare, only 0.05% 1%.
Case Presentation : A 41 years female cannot defecate and fart since 3 days, history of anal mass since 5
months ago, rectal bleeding, weight loss, lost of appetite. Small bowel obstruction and rectum mass was
obtained from Abdominal CT-Scan. Laparatomy was performed and founded ileo-ileal intussusception
caused by tumor 50cm from ileocaecal valve continuous with Resection anastomosis Ileo-Ileal end to end.
Miles procedure for proximal anorectum tumor. Post operative diagnosis was Ileum Tumor suspect
Malignancy cT4N1M0. Paraffin block are MM Ileum Metastasis, rectum, and sigmoid.
Conclusions : MM can metastasis to GI tract, bone, brain. In this case we found metastasis at brain, ileum
and anorectum. Paliative operation was performed to resolved obstruction.
Keywords : melanoma malignant, small bowel, obstruction, metastasis, intussusception

Intususepsi Usus Halus dan Tumor Anorektal Akibat Metastasis Melanoma Maligna
JA Uwuratuw, Mappincara.
Divisi Bedah Digestive, Departemen Ilmu Bedah FK Unhas

Abstrak:
Pendahuluan: Angka kejadian Metastasis Melanoma Maligna (MM) usus halus sebesar 1% 2%. Gejala klinis berupa rasa nyeri, konstipasi, obstruksi, perforasi, perdarahan dan anemia.
Kasus MM pada kolon sangat jarang, hanya 12 kasus dilaporkan oleh literatur terbaru.
Sedangkan, Melanoma Maligna Anorektal (MMA) sangat jarang sekitar 0,05% - 1%.
Presentasi kasus: Perempuan usia 41 tahun keluhan tidak BAB dan flatus sejak 3 hari, riwayat
benjolan di anus sejak 5 bulan sebelumnya. Riwayat BAB darah, penurunan berat badan, nafsu
makan. Pada pemeriksaan CT-Scan abdomen didapatkan obstruksi usus halus dan massa pada
rektum. Dilakukan laparotomi tampak intususepsi ileo-ileal karena tumor 50cm dari valvula
ileocaecal. Dilakukan reseksi anastomosis Ileo-Ileal end to end. Tumor pada ano-rektum
proximal dilakukann Miles procedure. Diagnosis post operasi Tumor ileum suspek malignansi
cT4N1M0, tumor rektum suspek malignansi cT4N1M0. Blok parafin adalah metastasis MM
ileum, rektum dan sigmoid.
Kesimpulan: MM dapat metastasis ke saluran GI, tulang, otak. Pada pasien ini ditemukan lesi
metastasis otak dan ileum anorektum. Operasi paliatif untuk mengatasi keluhan obstuksi.
Kata kunci: melanoma maligna, usus halus, obstruksi, metastasis, intususepsi