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The Korean Journal of Pathology 2008;42(3): 165-168.
Brown Bowel Syndrome that Developed after Total Gastrectomy: A Case Report.
Sun Ah Lee, Hyung Kyung Kim, Ji Yoon Bae, Hanna Kang, Ha Rin Cheong, Hye Kyung Jung, Min Sun Cho
1Department of Pathology, Ewha Womans University School of Medicine, Seoul, Korea. mcho1124@ewha.ac.kr
2Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea.
ABSTRACT
The brown bowel syndrome (BBS) is an uncommon disorder, which is characterized by brown pigmentation of the intestine due to the accumulation of lipofuscin in the smooth muscle cells. Vitamin E deficiency has generally been considered as the cause of this malady. BBS has been reported in a wide variety of malabsorptive diseases involving the pancreas, liver and gastrointestinal tract. We report here on a case of brown bowel syndrome that occurred in a 73-year-old man who had undergone total gastrectomy 11 years ago for gastric adenocarcinoma. He has complained about intestinal obstructive symptoms for several years, and these symptoms were recently aggravated. He showed a low serum concentration of total protein, albumin and cholesterol, and he had been treated for megaloblastic anemia due to vitamin B12 and folate deficiency several months ago. The resected small bowel showed lipofuscin deposition in the muscle layer of the intestine and large vessels. The electron microscopic examination revealed multiple electron dense lipofuscin deposits with irregular shapes and sizes in the cytoplasm.
Key Words: Lipofuscin; Ceroid; Enteropathy; Postgastrectomy syndrome