HEMORRHAGIC SMALL BOWEL MELANOMA METASTASIS: A CLINICAL RARITY

Aims:

We report a clinical case of spontaneously hemorrhagic small bowel metastasis in a malignant melanoma patient with anemia, diagnosed using small bowel capsule endoscopy.

Methods:

A 67 y.o. male patient with the diagnosis of malignant melanoma presented with severe anemia and vertigo on admission. Lab: (hemoglobin 5.8 g/dl, hematocrit: 19%) The biochemical lab control was unremarkable. We applied the standard diagnostic protocol for GI-bleeding investigation including a gastroscopy, colonoscopy, small-bowel capsule endoscopy, as well as abdominal sonography and an extended restaging protocol including CT- lung and abdomen, echocardiography and ECG.

Results:

Gastroscopy and coloscopy were not conclusive for active bleeding source. Colonoscopy revealed a non-hemorrhagic melanoma metastasis in cecum. Small-bowel capsule endoscopy provided evidence for numerous (more than 30), actively hemorrhagic metastases disseminated in both the jejunum and ileum. It is worth noticing that CT-Abdomen was unremarkable for small bowel findings. Due to a diffuse metastatic disease diagnosed in heart, brain, liver, spleen and bone metastasis, the patient was treated in a conservative/palliative basis with blood transfusion.

Conclusions:

Small bowel capsule endoscopy is a sensitive and specific method which can provide precious information about GI-bleeding of unknown origin when classical diagnostic methods are non conclusive, such as in the presented case of hemorrhagic small bowel metastatic disease of a malignant melanoma.