Acute mesenteric ischaemia and unexpected death

Discipline of Anatomy and Pathology, School of Health Sciences, The University of Adelaide, Adelaide, SA 5005, Australia.
Journal of Forensic and Legal Medicine (Impact Factor: 0.76). 05/2012; 19(4):185-90. DOI: 10.1016/j.jflm.2011.12.023
Source: PubMed


Acute mesenteric ischaemia is a vascular emergency that arises when blood flow to the intestine is compromised leading to tissue necrosis. It is primarily a condition of the elderly associated with significant morbidity and mortality. Causes include arterial thromboembolism, venous thrombosis and splanchnic vasoconstriction (so-called nonocclusive mesenteric ischaemia). Reperfusion injury and breakdown of the intestinal mucosal barrier lead to metabolic derangements, sepsis and death from multiorgan failure. The diagnosis may be difficult to make clinically and numbers of cases are increasing due to ageing of the population. The clinical and pathological features are reviewed with discussion of predisposing conditions. Careful dissection of the mesenteric vasculature is required at autopsy with appropriate histologic sampling and documentation of associated comorbidities. Other organs need to be checked for thrombi and the possibility of testing for inherited thombophilias should be considered. Toxicological evaluation, particularly in younger individuals, may reveal evidence of cocaine use. On occasion no obstructive lesions will be demonstrated, however the confounding effects of post-mortem autolytic and putrefactive changes may mean that nonocclusive mesenteric ischaemia may be difficult to diagnose.

Download full-text


Available from: Roger W Byard, Feb 18, 2014
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The increasing numbers of obese and morbidly obese individuals in the community are having a direct effect on forensic facilities. In addition to having to install more robust equipment for handling large bodies, the quality of autopsy examinations may be reduced by the physical difficulties that arise in trying to position bodies correctly so that normal examinations can proceed. Accelerated putrefaction is often an added complication. Metabolic disturbances resulting from obesity increase susceptibility to a range of conditions that are associated with sudden and unexpected death, and surgery may have increased complications. The rates of a number of different malignancies, including lymphoma, leukemia, melanoma and multiple myeloma, and carcinomas of the esophagus, stomach, colon, gallbladder, thyroid, prostate, breast and endometrium, are increased. In addition, obese individuals have higher rates of diabetes mellitus, and sepsis. The unexpected collapse of an obese individual should raise the possibility of a wide range of conditions, many of which may be more difficult to demonstrate at autopsy than in an individual with a normal body mass index. Although sudden cardiac death due to cardiomegaly, pulmonary thromboembolism, or ischemic heart disease may be the most probable diagnosis in an unexpected collapse, the range of possible underlying conditions is extensive and often only determinable after full postmortem examination.
    Forensic Science Medicine and Pathology 03/2012; 8(4):402-13. DOI:10.1007/s12024-012-9322-5 · 1.98 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Fatal complications of peptic ulcer disease usually involve either perforation or hemorrhage. The case of a 27-year-old female is reported who was found dead at her home address. The autopsy revealed a perforated pyloroduodenal ulcer with localized abscess formation in the lesser sac behind the stomach and established peritonitis. In addition, there was significant hemorrhage with filling of the stomach with fresh blood and the intestine with large amounts of fresh blood and melena. Death was caused by the synergistic effects of both sepsis and significant upper gastrointestinal hemorrhage due to a perforating and penetrating peptic ulcer. Rarely cases of upper gastrointestinal disease may involve more than one fatal mechanism.
    Rechtsmedizin 12/2012; 22(6):482-484. DOI:10.1007/s00194-012-0858-1 · 0.35 Impact Factor
  • Source

    Forensic Science Medicine and Pathology 04/2013; 10(1). DOI:10.1007/s12024-013-9444-4 · 1.98 Impact Factor
Show more