Zhang ZX, Jin BW, Wang S, Tao KL. Massive gastric perforation in a patient with mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes: A case report. World J Gastrointest Surg 2026; 18(5): 117633 [DOI: 10.4240/wjgs.v18.i5.117633]
Corresponding Author of This Article
Ke-Long Tao, Professor, Department of Gastrointestinal Surgery, Shaoxing People’s Hospital (The First Affiliated Hospital of Shaoxing University), No. 568 Zhongxing North Road, Shaoxing 312000, Zhejiang Province, China. fykelong@163.com
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Gastroenterology & Hepatology
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case-report
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Zhang ZX, Jin BW, Wang S, Tao KL. Massive gastric perforation in a patient with mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes: A case report. World J Gastrointest Surg 2026; 18(5): 117633 [DOI: 10.4240/wjgs.v18.i5.117633]
World J Gastrointest Surg. May 27, 2026; 18(5): 117633 Published online May 27, 2026. doi: 10.4240/wjgs.v18.i5.117633
Massive gastric perforation in a patient with mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes: A case report
Zhen-Xing Zhang, Bo-Wen Jin, Shan Wang, Ke-Long Tao
Zhen-Xing Zhang, Ke-Long Tao, Department of Gastrointestinal Surgery, Shaoxing People’s Hospital (The First Affiliated Hospital of Shaoxing University), Shaoxing 312000, Zhejiang Province, China
Bo-Wen Jin, School of Medicine, Shaoxing University, Shaoxing 312000, Zhejiang Province, China
Shan Wang, Department of Special Examination, Shaoxing People’s Hospital (The First Affiliated Hospital of Shaoxing University), Shaoxing 312000, Zhejiang Province, China
Co-corresponding authors: Shan Wang and Ke-Long Tao.
Author contributions: Zhang ZX and Wang S contributed to manuscript writing and editing, and data collection; Jin BW contributed to data analysis; Tao KL contributed to conceptualization and supervision; Wang S, Tao KL they contributed equally to this article, they are the co-corresponding authors of this manuscript; and all authors have read and approved the final manuscript.
Supported by the Shaoxing Bureau of Science and Technology Foundation, Zhejiang Province, China, No.2023A14006.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Ke-Long Tao, Professor, Department of Gastrointestinal Surgery, Shaoxing People’s Hospital (The First Affiliated Hospital of Shaoxing University), No. 568 Zhongxing North Road, Shaoxing 312000, Zhejiang Province, China. fykelong@163.com
Received: December 18, 2025 Revised: January 21, 2026 Accepted: March 4, 2026 Published online: May 27, 2026 Processing time: 160 Days and 8.5 Hours
Abstract
BACKGROUND
Mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS) is a rare genetic disorder that is defined clinically by stroke-like episodes, encephalopathy, manifestations of mitochondrial dysfunction. MELAS concurrent with gastrointestinal perforation is rare, and concurrent with massive gastric perforation is extremely rare.
CASE SUMMARY
A 51-years-old woman was admitted to our department for treatment from the gastrointestinal sequelae of MELAS syndrome. She presented with complaints of abdominal pain accompanied by paroxysmal lumbar pain and nausea with vomiting. She underwent a whole abdominal computed tomography scan in the emergency department, which indicated gastrointestinal perforation. This resulted in emergent surgery at which a massive perforation of the stomach was identified. The patient underwent repair of a gastric rupture and received further treatment in the intensive care unit postoperatively.
CONCLUSION
MELAS concurrent with massive gastric perforation is extremely rare, but clinicians should be vigilant about the rare but potentially devastating gastrointestinal consequences of mitochondrial diseases in MELAS patients.
Core Tip: Massive gastric perforation is an exceptionally rare but life-threatening gastrointestinal complication of mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS). MELAS concurrent with gastrointestinal perforation is rare, and concurrent with massive gastric perforation is extremely rare. This case highlights that acute abdominal pain in MELAS patients may signal catastrophic perforation requiring urgent imaging and surgical intervention. Early recognition and multidisciplinary management are essential to reduce morbidity and improve outcomes.
