Metastatic malignant melanoma of the small bowel is a rare and aggressive disease, without specific symptoms. Due to that, most cases are diagnosed in advanced stages, presenting as an acute abdomen in situations of bowel obstruct ion or perforation.
We present the case of a 56-year-old male who was admitted for generalized edema and developed an acute abdomen secondary to perforation of small bowel malignant melanoma metastasis, with lymph node invasion. Segmental bowel resection was performed with peritoneal lavage. The patient developed another metastasis perforation in the first postoperative week and was later transferred to a palliative care institution. Tumor perforation is a very rare presentation of small bowel metastatic melanoma, being a condition with a difficult diagnosis and poor outcome.