856 Malignant Melanoma of the Small Bowel Causing Multiple Simultaneous Intussusceptions; a Rare Presentation

Background The rare occurrence of primary melanoma in the small bowel, particularly leading to simultaneous multiple intussusceptions, presents intricate challenges in diagnosis and management. We detail a case of a male in his late 50s with multiple intussusceptions secondary to melanoma deposits in the proximal small bowel. Case presentation 55-year-old patient presented with severe abdominal pain for 3 weeks, dark stools, unexplained anaemia, and unintentional weight loss. Imaging revealed small bowel obstruction due to intussusception caused by a polypoidal point, prompting surgical intervention. The initial laparotomy led to resecting a segment of the small bowel with the polyp, histopathology revealed malignant melanoma. Post-operatively the patient showed improvement but faced recurrent intussusceptions. Tertiary centre/multi-disciplinary team advise was sought and A PET-CT scan was done that identified 3 hotspots (likely polyps) in the proximal small bowel. Patient underwent a repeat laparotomy where 3 polyps were noted causing simultaneous intussusceptions and 68cm of proximal small bowel was resected with ileo-ileal anastomosis performed. Discussion This unique case highlights the rarity of simultaneous multiple intussusceptions due to small bowel melanoma deposits and emphasises the role of surgical intervention. While recognising the benefit of polyp resection during the initial surgery, the case suggests the importance of proactive management and multi-disciplinary approaches for optimal outcomes in such complex scenarios. Key takeaways include maintaining a high index of suspicion for malignancy in unusual presentations, advocating for timely expert consultation, emphasizing small bowel resection for intussusceptions, and considering resecting all identified polyps to prevent complications and improve patient outcomes.