Presentation
Known previous upper GI melanoma resected. Now off treatment. Vomiting bile stained fluid. ?Gastric outlet obstruction. ?Adhesions
Patient Data
Previous duodenojejunal anastomosis. At the anastomosis there are multiple enhancing intraluminal soft tissue masses consistent with disease recurrence. There is moderate dilatation of the duodenum proximally suggesting partial obstruction. The stomach is not dilated. Numerous other intraluminal soft tissue masses within the proximal jejunum on the left. There is mural thickening of these loops of jejunum. There is also abnormal soft tissue encasing the jejunal vessels with enlarged adjacent lymph nodes.
Atrophy of the lower pole of the left kidney. The right kidney is unremarkable. Tiny hypodensity in segment 7 of the liver. The spleen, pancreas and gallbladder are unremarkable. The portal and splenic veins are patent. Diverticulum arising from the left lateral wall of the bladder. Uncomplicated sigmoid diverticula disease. Partially imaged tiny nodular opacities anteriorly in the right lung. No suspicious osseous lesions.
Case Discussion
In the setting of known melanoma these findings a characteristic for metastatic deposits. Metastases to the gastrointestinal tract are rare but melanoma is the most common primary and the small bowel is the commonest location.
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