Case Report
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World J Gastroenterol. Nov 7, 2012; 18(41): 5986-5989
Published online Nov 7, 2012. doi: 10.3748/wjg.v18.i41.5986
Mucosal necrosis of the small intestine in myopathy, encephalopathy, lactic acidosis, and stroke-like episodes syndrome
Keita Fukuyama, Yasuhide Ishikawa, Tetsuro Ogino, Hidenobu Inoue, Ryoya Yamaoka, Tetsuro Hirose, Tomohiko Nishihira
Keita Fukuyama, Yasuhide Ishikawa, Hidenobu Inoue, Ryoya Yamaoka, Tetsuro Hirose, Tomohiko Nishihira, Department of Gastroenterological Surgery, Takamatsu Red Cross Hospital, Takamatsu 760-0017, Japan
Tetsuro Ogino, Department of Pathology, Takamatsu Red Cross Hospital, Takamatsu 760-0017, Japan
Author contributions: Fukuyama K mainly contributed to this work; Ishikawa Y supervised the operation; Ogino T diagnosed the resected tissue; Fukuyama K, Ishikawa Y, Inoue H, Yamaoka R, Hirose T, and Nishihira T wrote the paper.
Correspondence to: Keita Fukuyama, MD, Department of Gastroenterological Surgery, Takamatsu Red Cross Hospital, 4-1-3 Banchou, Takamatsu 760-0017, Kagawa, Japan. fk506.cni@gmail.com
Telephone: +81-87-8317101 Fax: +81-87-8347809
Received: July 13, 2012
Revised: August 17, 2012
Accepted: August 25, 2012
Published online: November 7, 2012
Abstract

This report presents a case of massive mucosal necrosis of the small intestine in a patient with mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS), which particularly affects the brain, nervous system and muscles. A 45-year-old Japanese female, with an established diagnosis of MELAS, presented with vomiting. Computed tomography showed portomesenteric venous gas and pneumatosis intestinalis. She underwent a resection of the small intestine. A microscopic study showed necrosis of the mucosa and vacuolar degeneration of smooth muscle cells in the arterial wall. Immunohistochemistry showed anti-mitochondrial antibody to be highly expressed in the crypts adjacent the necrotic mucosa. The microscopic and immunohistochemical findings suggested the presence of a large number of abnormal mitochondria in MELAS to be closely linked to mucosal necrosis of the small intestine.

Keywords: Myopathy, encephalopathy, lactic acidosis, and stroke-like episodes syndrome; Acute mesenteric ischemia; Immunohistochemistry; Anti-mitochondrial antibody; Pathology