A secondary jejunal malignant melanoma from nasal mucosal melanoma: Case report

Melanomas most commonly localized in the skin can arise anywhere in the body, and approximately 5% of all melanomas appear in other sites of mucosal surfaces out of skin. Primary melanoma from nasal mucosa is quite rare. We present this case: a 46-year-old man had complained a pain in the left upper abdomen for 2 months when he was admitted to the Northern Jiangsu People’s Hospital. The pain was paroxysmal and enhanced when eating. There was no nausea, vomiting, or anorexia. There had been no change in weight in previous months. This patient had a past history of surgery for nasal mucosal malignant melanoma 2 years ago. Abdominal enhanced computed tomography (CT) indicated that a mass originated from small bowel and occupied the left upper abdomen. The patient underwent a laparotomy during which a black lesion measuring about 5 cm × 5 cm × 4 cm was found at the jejunum and resected totally together with partial jejunum. The patient was eventually diagnosed as secondary jejunal malignant melanoma from nasal mucosal melanoma. For patients with a history of melanoma, gastrointestinal metastasis should be considered when patients develop gastrointestinal symptoms. In addition, we recommend positive anti-tumor therapy after surgery.

Metabolic effects of an entero-omentectomy in mildly obese type 2 diabetes mellitus patients after three years

BACKGROUND

Various digestive tract procedures effectively improve metabolic syndrome, especially the control of type 2 diabetes mellitus. Very good metabolic results have been shown with vertical gastrectomy and entero-omentectomy; however, the metabolic effects of an isolated entero-omentectomy have not been previously studied.

METHODS

Nine patients with type 2 diabetes mellitus and a body mass index ranging from 29 to 34.8 kg/m² underwent an entero-omentectomy procedure that consisted of an enterectomy of the middle jejunum and exeresis of the major part of the omentum performed through a mini-laparotomy. Glucagon-like peptide-1 and peptide YY were measured preoperatively and three months following the operation. Fasting and postprandial variations in glycemia, insulinemia, triglyceridemia, hemoglobin A1c, and body mass index were determined in the preoperative period and 3, 18 and, 36 months after the operation.

RESULTS

All patients significantly improved the control of their type 2 diabetes mellitus. Postprandial secretion of peptide YY and Glucagon-like peptide-1 were enhanced, whereas hemoglobin A1c, fasting and postprandial glucose, insulin, and triglyceride levels were significantly reduced. Mean body mass index was reduced from 31.1 to 27.3 kg/m². No major surgical or nutritional complications occurred.

CONCLUSIONS

Entero-omentectomy is easy and safe to perform. A simple reduction in jejunal extension and visceral fat causes important improvements in the metabolic profile.