Toxic Gangrenous Megacolon: A Novel Surgical Emergency in MELAS

MELAS syndrome (mitochondrial cytopathy, encephalomyopathy, lactic acidosis and stroke like episodes) is a syndrome in which signs and symptoms of gastro-intestinal disease are uncommon, if not rare. We describe a young female patient who presented as an acute surgical emergency, diagnosed as toxic mega colon necessitating an emergency total colectomy; the diagnosis of MELAS syndrome was made post-operatively. This diagnosis should be considered in patients presenting with acute ischemic colitis or toxic mega colon who have persistent lactic acidosis with encephalopathy and a stormy post-operative course.