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Chen X, Zhang HM, Zhou DD, Chen ZM, Wang B, Wang Z, Bai X. Diagnosis of Acute Pancreatitis Using Postmortem Computed Tomography and Postmortem Magnetic Resonance Imaging: A Case Report and a Review of Literature. Am J Forensic Med Pathol 2023; 44:340-344. [PMID: 37499163 DOI: 10.1097/paf.0000000000000862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
ABSTRACT Acute pancreatitis (AP) is inflammation of the pancreas, which may be due to a wide variety of etiologies that share a final common pathway of premature activation of pancreatic enzymes and resultant autodigestion of pancreatic parenchyma. Acute pancreatitis is easy to diagnose clinically, with the presence of at least 2 of the 3 criteria (upper abdominal pain, serum amylase or lipase level greater than 3 times the upper limit of normal, or characteristic findings on imaging studies) of the revised Atlanta classification. However, postmortem imaging examinations of pancreatitis are extremely rare, and very few successful cases have been reported. Here, we present a case report of a single patient who underwent autopsy and postmortem imaging. Postmortem computed tomography (PMCT) and postmortem magnetic resonance imaging (PMMRI) showed peripancreatic inflammation and acute peripancreatic fluid collection in the left anterior pararenal space, which is consistent with the examination by autopsy. The advantages of PMMRI in AP have also been demonstrated. Our study also confirmed the advantage of PMCT angiography in the diagnosis of AP. To the best of our knowledge, this is the first report of PMCT and PMMRI combined with postmortem pathology in the diagnosis of AP.
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Affiliation(s)
- Xin Chen
- From the Department of Radiology, The First Hospital of Jilin University
| | - Hui-Mao Zhang
- From the Department of Radiology, The First Hospital of Jilin University
| | - Dan-Dan Zhou
- From the Department of Radiology, The First Hospital of Jilin University
| | | | - Bo Wang
- Jilin University, Jilin, China
| | - Zhuo Wang
- From the Department of Radiology, The First Hospital of Jilin University
| | - Xiao Bai
- From the Department of Radiology, The First Hospital of Jilin University
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Navlani LL, Verma A, Meshram R, Vaibhav V, Parate SV. Challenges in Diagnosing Sudden Death Caused by Acute Hemorrhagic Pancreatitis: An Autopsy-Based Case Report. Cureus 2023; 15:e49500. [PMID: 38152772 PMCID: PMC10752382 DOI: 10.7759/cureus.49500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2023] [Indexed: 12/29/2023] Open
Abstract
Forensic pathologists frequently encounter cases of sudden natural death. Most sudden natural deaths are attributed to cardiac causes. Acute pancreatitis, especially hemorrhagic pancreatitis, is an infrequent yet critical contributor to sudden death. The role of a forensic pathologist is imperative in such cases to find out the cause of the sudden death and to either confirm or refute any allegations. In this context, we describe a case of a 34-year-old male who experienced sudden death due to acute hemorrhagic pancreatitis, highlighting the need for a detailed autopsy, pathophysiological insights, and diagnostic challenges.
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Affiliation(s)
- Lakhan Lal Navlani
- Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Rishikesh, IND
| | - Arushi Verma
- Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Rishikesh, IND
| | - Raviprakash Meshram
- Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Rishikesh, IND
| | - Vikas Vaibhav
- Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Rishikesh, IND
| | - Shailesh V Parate
- Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Rishikesh, IND
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Sudden and unexpected deaths due to non-traumatic abdominal disorders: A forensic perspective. J Forensic Leg Med 2022; 89:102355. [DOI: 10.1016/j.jflm.2022.102355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/08/2022] [Accepted: 04/23/2022] [Indexed: 12/22/2022]
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Ben Abderrahim S, Gharbaoui M, Békir O, Hamdoun M, Allouche M. Sudden death related to the gastrointestinal system in Tunisia: A 13 year autopsy study. J Forensic Sci 2021; 67:596-604. [PMID: 34897679 DOI: 10.1111/1556-4029.14953] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/21/2021] [Accepted: 11/29/2021] [Indexed: 12/20/2022]
Abstract
Sudden gastrointestinal (GI) death is an unexpected death due to digestive system causes mainly found after autopsy. The literature is rich in articles that studied sudden death due to cardiac causes while sudden GI deaths remain less well-documented. We retrospectively investigated all cases of gastrointestinal death at the Department of Forensic Medicine in Tunis, over 13 years (January 1, 2006 to December 31, 2018). Two hundred and eight cases were collected. The mean age of our series was 51.06 ± 20.99 years. No history of digestive disorders was reported in 78.4%, and no family history of sudden death was found in any cases. A male predominance was found in most epidemiological characteristics of the sample with a significant statistical rate in some features. Non-specific abdominal pain was the most described symptom (n = 92). Perforation of GI tract was the common mechanism involved in the death of 55 cases, of which 44 were related to ulcer perforation. These ulcer perforations were statistically more reported in smokers and people suffering from schizophrenia. Intestinal obstruction was the second commonest cause of death, mainly found in the elderly. Sudden death in children was most frequently caused by acute intussusception. This study highlights that systematic study of sudden death due to GI causes might provide opportunities to identify avenues for overall health improvement.
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Affiliation(s)
- Sarra Ben Abderrahim
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia
| | - Meriem Gharbaoui
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia
| | - Olfa Békir
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia
| | - Moncef Hamdoun
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia
| | - Mohamed Allouche
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia
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Hanley B, Chambers D. Significant and potentially overlooked causes of unexpected death outside the cardiovascular and central nervous system. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.mpdhp.2019.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Stoppacher R. Sudden Death Due to Acute Pancreatitis. Acad Forensic Pathol 2018; 8:239-255. [PMID: 31240041 PMCID: PMC6490125 DOI: 10.1177/1925362118782051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 04/22/2018] [Indexed: 12/29/2022]
Abstract
Acute pancreatitis can present as sudden, expected death and, therefore, fall under the jurisdiction of the medical examiner/coroner (ME/C). Although its etiologies are varied, alcohol abuse, trauma, and drugs are important to consider in the forensic setting. It is therefore important for the forensic pathologist to have an understanding of these and other etiologies, to have a functional knowledge of the pancreatic anatomy and physiology, and to be able to diagnose acute pancreatitis and distinguish it from postmortem artifact. This review will highlight the forensic aspects of acute pancreatitis, with particular focus on acute hemorrhagic pancreatitis. This will include an overview of the developmental anatomy and normal physiology of the pancreas, the various causes of pancreatitis that may result in deaths coming to the attention of the ME/C, the underlying pathophysiology of the disease, the postmortem diagnosis of acute pancreatitis, and ancillary studies that support the diagnosis. Acad Forensic Pathol. 2018 8(2): 239-255.
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Affiliation(s)
- Robert Stoppacher
- Robert Stoppacher MD, 100 Elizabeth Blackwell Street Syracuse NY 13210, US.
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Menezes RG, Padubidri JR, Raghavendra Babu YP, Naik R, Kanchan T, Senthilkumaran S, Chawla K. Sudden unexpected death due to strangulated inguinal hernia. Med Leg J 2016; 84:101-4. [PMID: 26837567 DOI: 10.1177/0025817216629848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sudden unwitnessed, unexpected deaths when the bodies are found in public places require a complete and meticulous medicolegal autopsy to ascertain the cause and manner of death to avoid further unnecessary investigations by the legal authorities. Such deaths attributed to gastrointestinal causes at autopsy are relatively uncommon. We report a case of sudden unexpected death due to strangulated inguinal hernia in a 60-year-old man. The body was discovered in a public area near a place of worship. The present case illustrates a potentially preventable sudden unexpected death due to a surgically correctable gastrointestinal condition. In the present case, the individual feared being hospitalised for treatment of his scrotal swelling with potential surgery and the eventual loss of daily income. In our opinion, such apprehensions may have delayed the potentially life-saving hospital surgical intervention in the individual.
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Affiliation(s)
| | | | | | - Ramadas Naik
- Yenepoya Medical College, Yenepoya University, Mangalore, India
| | - Tanuj Kanchan
- Kasturba Medical College (Affiliated with Manipal University), Mangalore, India
| | | | - Khushboo Chawla
- Kasturba Medical College (Affiliated with Manipal University), Mangalore, India
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Praveen S, Kamath S, Usha M, Akshith. Sudden natural death masquerading as accidental death - a case report. Med Leg J 2014; 83:22-5. [PMID: 24847044 DOI: 10.1177/0025817213517355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Things are not always what they seem at first sight. One should always be on the watch for more than presents itself as the main issue in the investigation of crime. Whenever a person dies at the scene of accident, it is inferred that the accident caused the death. But that does not mean that the inference is correct. A person who was suspected to have met with a road traffic accident after autopsy turned out to be a case of sudden natural death due to acute haemorrhagic pancreatitis. The case is reported as it is of medico-legal interest because a natural death appeared to be due to a traffic accident.
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Affiliation(s)
- S Praveen
- Department of Forensic Medicine, M.S. Ramaiah Medical College, Bangalore, Karnataka, India
| | - Sulatha Kamath
- Department of Pathology, M.S. Ramaiah Medical College, Bangalore, Karnataka, India
| | - M Usha
- Department of Pathology, M.S. Ramaiah Medical College, Bangalore, Karnataka, India
| | - Akshith
- Department of Forensic Medicine, M.S. Ramaiah Medical College, Bangalore, Karnataka, India
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Gervacio G, Lim M, Reganit P, Encinas M, Macapugay L, Palmero J, Nierras C, De Los Reyes C, Geronimo F. A case control study on autopsy findings in sudden unexplained nocturnal death syndrome. HEART ASIA 2014; 6:11-6. [PMID: 27326155 DOI: 10.1136/heartasia-2013-010431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 11/18/2013] [Accepted: 12/14/2013] [Indexed: 11/03/2022]
Abstract
AIM Sudden unexplained nocturnal death syndrome (SUNDS) has been linked to the Brugada syndrome. In some places, acute haemorrhagic pancreatitis is widely held to cause it. We conducted a systematic, controlled autopsy study on Filipino SUNDS victims to rule out structural heart findings as well as acute haemorrhagic pancreatitis as causes. METHODS AND RESULTS A case control autopsy study was conducted comparing SUNDS victims between 18 and 50 years of age who died within 1 h of symptom onset with age- and gender-matched controls. There were 24 SUNDS (mean age 34.5 years) and 24 controls (mean 32.7 years). The autopsy incidence of structural heart disease was 8.3% (95% CI (1% to 27%)) and focal pancreatic haemorrhage was 4.17% (95% CI (0.1% to 20%)) but zero for true acute haemorrhagic pancreatitis among SUNDS victims. Autopsy findings in SUNDS versus controls were not significantly different from each other, showing no diagnostic abnormality in any of the organs. There was no significant difference in the incidence of acute haemorrhagic pancreatitis in both the SUNDS and control groups. We did not find fetal dispersion of the atrioventricular (AV) node, sclerosis or fibrosis of the AV conduction system, in a substudy of SUNDS cases. CONCLUSIONS We have shown that there is no significant difference in the overall autopsy findings between SUNDS and controls. Autopsy findings were normal in 70% of SUNDS; no cardiac structural pathology was found in 87% of cases. Haemorrhagic pancreatitis is the cause of death in a minority of SUNDS. The cardiac conduction system is normal in a subgroup of SUNDS studied.
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Affiliation(s)
- G Gervacio
- Cardiovascular Section, Department of Medicine , University of the Philippines-Philippine General Hospital , Manila , Philippines
| | - M Lim
- Department of Pathology , University of the Philippines College of Medicine , Manila , Philippines
| | - P Reganit
- Cardiovascular Section, Department of Medicine , University of the Philippines-Philippine General Hospital , Manila , Philippines
| | - M Encinas
- Department of Pathology , University of the Philippines College of Medicine , Manila , Philippines
| | - L Macapugay
- Cardiovascular Section, Department of Medicine , University of the Philippines-Philippine General Hospital , Manila , Philippines
| | - J Palmero
- Crime Laboratory , Philippine National Police , Quezon , Philippines
| | - C Nierras
- Cardiovascular Section, Department of Medicine , University of the Philippines-Philippine General Hospital , Manila , Philippines
| | - C De Los Reyes
- Cardiovascular Section, Department of Medicine , University of the Philippines-Philippine General Hospital , Manila , Philippines
| | - F Geronimo
- Cardiovascular Section, Department of Medicine , University of the Philippines-Philippine General Hospital , Manila , Philippines
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Mittal G, Menon A, Krishnan M, Nambiar S, Unnikrishnan B, Kanchan T. Analysis of sudden deaths in a coastal region of South India. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2014. [DOI: 10.7713/ijms.2013.0041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Padubidri JR, Menezes RG, Pant S, Shetty SB. Deaths among women of reproductive age: A forensic autopsy study. J Forensic Leg Med 2013; 20:651-4. [DOI: 10.1016/j.jflm.2013.03.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 01/12/2013] [Accepted: 03/17/2013] [Indexed: 10/26/2022]
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