title: Pathological changes in the gastrointestinal tract of a heavily radiation-exposed worker at the Tokai-mura criticality accident.
abstract: Gastrointestinal syndrome after high-dose acute radiation whole body exposure is difficult to treat, although it is a well-known complication. In this report, we describe the clinical and pathological features of a patient who died after the criticality accident which occurred in Japan on 30 September 1999. The patient was estimated to have been exposed to 16-25 Gy equivalent of gamma ray, and died of multiple organ failure after acute radiation syndrome, especially gastrointestinal syndrome, on day 82. The stomach and small intestine contained a large amount of blood clots and the gastrointestinal epithelial cells were almost totally depleted at autopsy. In addition, the degree of the mucosal damage was dependent on the segment of the gastrointestinal tract; the mucosa of stomach, ileum and ascending colon was entirely depleted, but the esophagus, descending and sigmoid colon and rectum retained a small portion of the epithelial cells. From the posture of the patient at the time of exposure, the absorbed dose was presumed to be highest in the right-anterior abdomen. This agreed with the pathological differences in the mucosal damage by the position in the abdomen, which depended presumably on the radiation dose. This is the first report documenting the relationship between the absorbed dose and the severity of gastrointestinal damages in vivo.
authors.affiliation: Department of Radiology, University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Igaki
authors.forename: Keiichi
authors.initials: K
authors.lastname: Nakagawa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Uozaki
authors.forename: Masaaki
authors.initials: M
authors.lastname: Akahane
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Hosoi
authors.forename: Masashi
authors.initials: M
authors.lastname: Fukayama
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Miyagawa
authors.forename: Makoto
authors.initials: M
authors.lastname: Akashi
authors.forename: Kuni
authors.initials: K
authors.lastname: Ohtomo
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Maekawa
mesh_terms: D000328:Adult; D003106:Colon / Q000473:pathology* / Q000528:radiation effects; D018450:Disease Progression; D017809:Fatal Outcome; D005720:Gamma Rays / Q000009:adverse effects*; D041981:Gastrointestinal Tract / Q000473:pathology* / Q000528:radiation effects; D006801:Humans; D007082:Ileum / Q000473:pathology* / Q000528:radiation effects; D007564:Japan; D008297:Male; D011832:Radiation Injuries / Q000209:etiology / Q000473:pathology*; D018788:Radioactive Hazard Release