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Non-occlusive mesenteric ischemia induced by methamphetamine: an autopsy case report
Ayumi Nitta1, Takahiro Umehara1, Toshiko Tanaka1
1Department of Forensic Medicine, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Fukuoka, Japan.
Forensic Science, Medicine, and Pathology
|January 14, 2026
Summary
Methamphetamine (MA) use can cause non-occlusive mesenteric ischemia (NOMI), a serious intestinal condition. This case report details a fatal NOMI event in a methamphetamine user, even with non-lethal MA blood levels.
Area of Science:
- Forensic Pathology
- Toxicology
- Gastroenterology
Background:
- Non-occlusive mesenteric ischemia (NOMI) is acute intestinal ischemia without arterial blockage.
- Vasoconstrictive agents are potential causes of NOMI.
- Methamphetamine (MA) is a potent sympathomimetic agent.
Purpose of the Study:
- To report the first documented Japanese autopsy case of NOMI induced by methamphetamine (MA).
- To investigate the relationship between MA use and NOMI in a sudden death case.
Main Methods:
- Forensic autopsy including gross and histopathological examination of the small intestine and mesenteric arteries.
- Post-mortem toxicological analysis to determine blood MA concentration.
Main Results:
- Autopsy revealed a dilated small intestine with non-contiguous ischemic necrosis and no organic stenosis of mesenteric arteries.
- Histopathology confirmed NOMI. Blood MA concentration was toxic but below the fatal threshold.
- The fatal outcome suggested MA's role in NOMI, potentially due to prolonged mucosal exposure.
Conclusions:
- Methamphetamine-induced NOMI should be considered in the differential diagnosis of sudden death in MA users.
- Fatal ischemic complications can occur even at non-fatal MA concentrations.
- Prolonged oral MA exposure may intensify local vasoconstriction, leading to intestinal ischemia.
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