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Sudden unexpected death due to rupture of the stomach

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Abstract

We report a case of sudden unexpected death due to rupture of the stomach. A 49-year-old man was found dead in a public lavatory. Autopsy findings revealed two rupture wounds measuring 14 cm and 6 cm located in the fundus of stomach at the side of the greater curvature despite of any superficial injury. The deceased had an ulcer in the lesser curvature of stomach, and dilation in this area was expected to be impaired. Under this condition, excessive over-eating resulting in over-extension of the stomach wall at the greater curvature was speculated to have caused stomach rupture.

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... 42,43 Anorexia nervosa, polyphagia, volvulus, superior mesenteric artery syndrome and bulimia nervosa have all been associated with cases of gastric dilatation and rupture. 42 Ishikawa et al. 44 describe a case of sudden death due to gastric rupture suspected to have been induced by excessive eating. Regarding the rarity of this condition, they reported only 47 cases over 50 years in the Japanese literature. ...
... Regarding the rarity of this condition, they reported only 47 cases over 50 years in the Japanese literature. 44 They further reported female dominance, with a male:female ratio of 1:4, and mortality, even with surgical intervention, at 65%. 44 Gastric rupture and/or shock secondary to compression of inferior vena cava and disturbance of portal blood flow resulting from gastric dilatation have been implied as reasons for mortality. 43 Hypovolaemic shock may occur in anorexic patients because of an imbalance in circulatory minerals and fluids as a result of retention of gastric juices. ...
... Regarding the rarity of this condition, they reported only 47 cases over 50 years in the Japanese literature. 44 They further reported female dominance, with a male:female ratio of 1:4, and mortality, even with surgical intervention, at 65%. 44 Gastric rupture and/or shock secondary to compression of inferior vena cava and disturbance of portal blood flow resulting from gastric dilatation have been implied as reasons for mortality. 43 Hypovolaemic shock may occur in anorexic patients because of an imbalance in circulatory minerals and fluids as a result of retention of gastric juices. ...
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Gastrointestinal conditions are a less common cause of sudden unexpected death when compared to other conditions such as cardiovascular conditions, but they are equally important. Various congenital and acquired gastrointestinal conditions that have resulted in sudden unexpected death are discussed. The possible lethal mechanisms behind each condition, along with any associated risk factors or secondary diseases, have been described. Through this article, we aim to highlight the need for physicians to prevent death in such conditions by ensuring that subclinical cases are diagnosed correctly before it is too late and by providing timely and efficacious treatment to the patient concerned. In addition, this review would certainly benefit the forensic pathologist while dealing with cases of sudden unexpected death due to gastrointestinal causes. This article is a review of the major gastrointestinal causes of sudden unexpected death. In addition, related fatal cases encountered occasionally in forensic autopsy practice are also included. There are several unusual and rare causes of life-threatening gastrointestinal bleeding that may lead to sudden unexpected death to cover all the entities in detail. Nevertheless, this article is a general guide to the topic of gastrointestinal causes of sudden unexpected death.
... The mortality of GR even with surgical intervention was reported to be up to 65%. Delayed diagnosis and metabolic acidosis are associated with poor prognosis and increased mortality; surgical treatment is important for survival 1,4,7 . ...
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Idiopathic gastric rupture is extremely rare condition in children. We report herein a 4-years-old girl with Idiopathic GR who presented with shock. Resuscitation and early surgical intervention led to saving the child's life.
... Fourthly, there was sudden gastrointestinal death as was reported from India [12]. In 49-yeer-old Japanese [13], death from gastric rupture had occurred in a public lavatory. Finally, let me add the lesson taught by my co-author, an Irish Missionary doctor, Twomey [14], seeing that she worked assiduously in the Igbo hinterland. ...
... However, these cases have been occurred in very high doses that due to lack of control group, it cannot only be related to sodium bicarbonate. These items including stomach rupture following a long-term use of high dose of sodium bicarbonate [56,57], metabolic alkalosis [58], and cardiac arrhythmia due to overdose has been reported [59]. ...
Article
Sodium bicarbonate or baking soda is a chemical compound dissolved in water which is widely used as an additive in foods and mineral water and as a medicine. In Iran, due to the introduction of harmful effects of this compound, using it in baking is prohibited. Therefore, we tried to search and evaluate all health effects of using this compound with a systematic review. In this study, all available evidences on the beneficial and harmful effects of sodium bicarbonate were searched. The method was based on systematic study of reputable databases including Embase, Ovid, Scopus, Pubmed and ISI Web of science. Invalid studies were found that shows the relationship of harmful effects of sodium bicarbonate on general health. In addition to that, the studies showed therapeutic aspects and useful effects of this material. Some studies showed the harmful effects of therapeutic using of sodium bicarbonate with high dose that randomly happened. Reviewing of credible studies showed that not only using sodium bicarbonate is not harmful for human health, but also using it as a drug can be useful in treatment and relief of some diseases.
... The viral nature suggested by the histological aspect of the myocarditis requires further investigations such as positive amplification for an enteroviral genome by reverse transcriptase PCR. In the last years, many case reports of sudden death have been published, showing rare causes of sudden death which are various and not always cardiac67891011121314. These case reports stressed the importance of a complete autopsy with the use of classical complementary techniques, especially histological techniques and neuropathology, but also in some cases with the use of more specific techniques carried out in the living patient such as hemoglobin electrophoresis for the diagnosis of sickle cell syndrome [8]. ...
Article
Sudden death is now currently described as natural unexpected death occurring within 1 h of new symptoms. Most studies on the subject focused on cardiac causes of death because most of the cases are related to cardiovascular disease, especially coronary artery disease. The incidence of sudden death varies largely as a function of coronary heart disease prevalence and is underestimated. Although cardiac causes are the leading cause of sudden death, the exact incidence of the other causes is not well established because in some countries, many sudden deaths are not autopsied. Many risk factors of sudden cardiac death are identified: age, gender, heredity factors such as malignant mutations, left ventricular hypertrophy and left ventricle function impairment.
Article
Binge eating is characterised by the ingestion of large quantities of food in a short time. Cases in the literature deal exclusively with gastric perforation in people with a history of anorexia nervosa, binge eating disorder or bulimia nervosa. We report the case of a young woman with no previous diagnosis of mental illness and a history of only two binge-eating episodes that occurred a few years earlier. She died suddenly during a binge-eating episode from stomach rupture resulting from a single perforation of the stomach with leakage of food material within the abdominal cavity. There was no sign of gastric necrosis or peritonitis. The deceased died quickly. Our case, which appears unique in the literature, shows that there is a risk of death even in people with no diagnosis of eating disorders and a history of only few and isolated binge-eating episodes. Physicians should carefully investigate a patient's history to assess any risks.
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A 72-year-old woman had a history of carcinoma of the hypopharynx treated by total laryngectomy, circumferential pharyngectomy and free jejunal graft. Endoscopic dilation of the pharyngojejunal anastomotic stricture resulted in synchronous perforations of the oesophagus and stomach. We postulate that the perforations were caused by high intraoesophageal and intragastric pressure resulted from air insufflation during the procedure; in a situation simulating closed-loop obstruction, because of proximal obstruction by the endoscope at the stricture site and distal obstruction by pylorospasm. The sites of perforations were inherent points of weakness at the left side of the distal oesophagus and at the high lesser curve of stomach. Satisfactory outcome of our patient was attributed to prompt diagnosis and surgical repair. Endoscopists should be aware of this possibility during oesophagogastroduodenoscopy and dilation. Rapid and over insufflation of air should be avoided.
Article
Sudden death is now currently described as natural unexpected death occurring within 1 h ofnew symptoms. Although cardiac causes are the leading cause of sudden death, the exact incidence ofthe other causes are not well established because in some countries, many sudden deaths are not autopsied. Many risk factors of sudden cardiac death are identified: age, gender and heredity factors. Sudden death in the young always requires systematic forensic autopsy performed by at least one forensic pathologist. The present study shows the detailed analysis of incidence, clinical data, triggering events and pathological characteristics of sudden deaths in young adults on autopsy at National Institute of Forensic Medicine Hospital Kuala Lumpur.
Article
Das Rett-Syndrom geht mit gastrointestinalen Motilitätsstörungen und dem Verschlucken von Luft einher. Dies kann zur Magendilatation oder sogar selten zur Magenruptur führen. Ein 5 Jahre altes Mädchen mit Rett-Syndrom und akuter Bronchopneumonie verstarb plötzlich und unerwartet. Die rechtsmedizinische Sektion ergab eine letale Ruptur des Magens ohne Peritonitis mit 650 ml Flüssigkeit und Gas im Abdomen. Todesursache war ein neurogener Schock bei Magenperforation. Grund war eine lokale Nekrose der Magenwand. Die Diagnose eines akut lebensbedrohlichen Notfalls geistig retardierter Patienten kann erheblich erschwert sein. Abstract The Rett syndrome is associated with gastrointestinal disorders in motility and the swallowing of air, resulting in gastric distension or even rarely in gastric rupture. A 5-year-old girl with Rett syndrome and acute bronchopneumonia died suddenly and unexpectedly. A forensic autopsy revealed a lethal gastric rupture with 650 ml fluid and gas in the abdominal cavity without signs of peritonitis. The cause of death was neurogenic shock due to the gastric rupture caused by local necrosis of the gastric wall. Diagnosing an acute life-threatening emergency in mentally retarded patients can be very difficult.
Article
Die Bulimia nervosa ist eine Essstörung, von der vorwiegend junge Frauen betroffen sind. Todesfälle durch akute massive Magendilatation nach Heißhungerattacken mit und ohne Ruptur sind in der Literatur beschrieben. Der letale Verlauf der Bulimia nervosa einer 32 Jahre alt gewordenen Frau wird vorgestellt. Diese hatte einen Notdienst angerufen und um Medikamente zum Erbrechen gebeten. Eine stationäre Einweisung wurde vorgeschlagen; dies hatte die junge Frau abgelehnt. Später wurde sie in ihrer Wohnung tot aufgefunden. Bei der rechtsmedizinischen Sektion zeigte sich eine sehr schlanke Frau (Body-Mass-Index 21,35 kg/m2) mit geblähtem Bauch. Als Ursache fand sich ein massiv vergrößerter, den gesamten Bauchraum ausfüllender Magen mit einem Füllungsvolumen von 8540 ml. Als Todesursache werden funktionelle Dysregulationen diskutiert.
In the investigation of sudden death in adults, channelopathies, such as long QT syndrome, have risen to the fore in the minds of forensic pathologists in recent years. Examples of these disorders are touched upon in this review as an absence of abnormal findings at postmortem examination is characteristic and the importance of considering the diagnosis lies in the heritable nature of these conditions. Typically, a diagnosis of a possible channelopathy is evoked as an explanation for a 'negative autopsy' in a case of apparent sudden natural death. However, the one potential adverse effect of this approach is that subtle causes of sudden death may be overlooked. The intention of this article is to review and discuss potential causes of sudden adult death (mostly natural) that should be considered before resorting to a diagnosis of possible channelopathy. Nonetheless, it becomes apparent that many of the potential causes of sudden death can have a genetic basis. Thus, it becomes an important consideration that there may be a genetic basis to sudden death that extends beyond the negative autopsy.
Article
We report the first autopsy case of fatal gastric dilatation without rupture. A 31-year-old woman who lived alone was found dead in her living room. Despite being very thin, she showed marked abdominal distention. Autopsy and histological findings revealed that a severely distended stomach, of which walls notably thin and displayed transmural necrosis, occupied the entire abdominal cavity. Severe congestion was observed in the intestine and cecum. Theses findings suggest that bulimia nervosa together with anorexia nervosa resulted in rapid dilation of the stomach. We conclude that the cause of death was acute circulatory failure from hypovolemic shock that occurred following compression of the inferior vena cava and superior mesenteric vein, and by loss of circulatory volume to the third space.
Article
We report a case of fatal gastric rupture discovered after death, which developed due to a bulimic attack of a 19-year-old woman suffering from anorexia nervosa. An autopsy revealed an acute gastric dilatation and rupture without commonly observed ischemic damage of gastric wall structures. However, it may be difficult to determine the cause of death despite the marked findings. The death as a consequence of neurogenic shock accounts for all the results of gross examination and histologic analysis. This case is the first reported case of fatal gastric rupture of an anorectic patient discovered after death.
Article
SPONTANEOUS rupture of the stomach is a catastrophic entity. In none of the 45 cases hitherto reported was the diagnosis made prior to surgery or autopsy.1,2 Since this condition was not thought of as a diagnostic possibility, apparently few physicians are aware of it.Report of a Case A 65-year-old white woman was admitted to Montefiore Hospital complaining of generalized abdominal pain. Two hours prior to admission, while eating a large dinner, she noted abdominal discomfort. She took several effervescent antacid tablets dissolved in water, her abdomen became acutely distended, and she vomited repeatedly. She was known to have diverticulosis and had been on a self-imposed, low-calorie, low-residue diet for several weeks.Upon admission she was in acute distress with cold moist skin and a cyanotic appearance. The abdomen was distended, tympanitic, and rigid. Her blood pressure was 80/0 mm Hg; pulse rate, 130 beats per minute; and central-venous
Article
The diagnosis of spontaneous rupture of the stomach should be considered in all patients developing sudden and severe abdominal symptoms and shock. From a pathological point of view, it is unjustified not to entertain the diagnosis of spontaneous rupture of the stomach in cases of rapid and unexplained death presenting a large perforation of the stomach at autopsy. Awareness and proper study of this entity, at times, may solve a puzzling medico-legal problem. Useful diagnostic criteria are: (1) absence of autolytic changes throughout the body, (2) the size and the site of the perforation, (3) thinning of the surrounding gastric wall, (4) diastasis of the muscular layers around the perforation, (5) marked irregularity of the margins of the rupture, and (6) histological evidence of intramural hemorrhage, edema, or dissociation and disruption of muscle bundles, without inflammatory changes.
Article
A case is presented in which spontaneous rupture of the stomach occurred following ingestion of sodium bicarbonate. Only three similar cases have been reported in literature. The relevant literature and the theories concerning the etiology of this phenomenon are reviewed.
Article
Spontaneous rupture of the stomach is a grave condition leading to early death if untreated. Rupture usually follows some degree of gastric distension and is located along the lesser curvature whereas when vomiting is present, rupture usually occurs near the cardia. Necrosis of the gastric wall can also be associated. Treatment is immediate operation, and proper resection should be performed if there is any doubt about the viability of the gastric wall.
Article
Acute gastric dilatation, a rare complication of anorexia nervosa, is probably caused by a rare combination of factors. The psychiatric diagnosis and difficult behaviour may direct attention from the physical nature of the complication. Delay in starting treatment may jeopardise the survival of an emaciated patient. On the other hand, anorexia nervosa should be considered in patients presenting with acute gastric dilatation.
Article
Spontaneous rupture of the stomach is a rare but rapidly fatal accident. In the reported case, the galloping pace of deterioration claimed the life of the patient in spite of timely institution of resuscitative measures. However, in less catastrophic forms, provided the condition is recognised by its characteristic features, it is possible to improve the prognosis by expeditious surgical correction. It behoves us to briefly review the clinical features of this condition while presenting the case report.
Article
Explanation for this perforation was intriguing. When it was determined that the method of oxygen administration excluded it as a cause of gastric rupture, it was believed to be spontaneous. It did not appear likely that two breaths could rupture a stomach. However, when the matter was put to test in the autopsy room, a medical student with a vital capacity of 6,000 ml easily ruptured a stomach (along the lesser curvature) with one breath. Following this, a lesser lunged experimenter consistently ruptured cadaver stomachs with two breaths when the pylorus was occluded. It was not necessary to occlude the esophagogastric junction between breaths, as the esophagogastric angle was a sufficient valve to retain all but minimal amounts of air. All ruptures were along the lesser curvature.
Article
Psychogenic polyphagia in an 18 yr old girl resulted in total gastric infarction. Resection and subsequent Hunt Lawrence esophago jejunostomy resulted in the patient's return to society. It is almost impossible to produce experimental infarction of the stomach by arterial compromise alone; four major arteries of the stomach must be ligated along with 80% of the small vessels as well. When both arteries and veins are ligated, however, infarction occurs in every case. This occlusion of the venous drainage of the stomach, as a result of high intraluminal tension with increased intramural venous pressure, appears to be a highly significant factor and must have been important in this case. An additional feature worthy of note was the patient's inability to vomit.
Article
Two cases of spontaneous rupture of the stomach are described. The etiology and mechanism by which the tear was produced are discussed. Peritonitis, shock and respiratory impairment are responsible for the high mortality observed in this rare condition. Only immediate surgical intervention can prevent what is invariably a fatal outcome.
Article
A patient with spontaneous rupture of the stomach, treated successfully by a proximal gastrectomy, is described. The probable cause of the rupture was the ingestion of a large meal accompanied by functional blockage of the normal gastric outlets. Only immediate surgical intervention can reduce the high mortality rate associated with this rare condition.
Article
Spontaneous rupture of the stomach may occur in cases of abnormal distension and reduced emptying capacity, either by normal peristalsis or by vomiting, of the stomach. We present a case of spontaneous rupture of the stomach in which the dilatation was due to apple fermentation and gas formation in the stomach. Peristalsis was inadequate for stomach emptying due to impaction of apple skins in the duodenum. The inability to vomit was due to a Nissen fundoplication performed 18 months earlier.
Article
This is a report of a 22-year-old woman with treated anorexia nervosa who died of complications of acute gastric dilatation-that is, infarction and perforation with severe and irreversible shock. Binge eating and drinking, precipitated by emotional crises, contributed to her acute gastric dilatation. This complication of anorexia nervosa has been previously reported, but, unlike the others, this case ended fatally. The literature is reviewed.
Article
We experienced a case of rupture of the stomach which was a 80-year-old female, and had suffered from vomiting after lunch followed by abdominal pain and distention. Physical examination revealed muscle guarding and radiography depicted massive free gas in the abdominal cavity. At laparotomy, a rupture was located close by the anterior wall of the greater curvature of the stomach. There was no evidence of ulceration, tumorigenesis, or traumatic history. The operation consisted of debridement around the rupture site and subsequent closure. The rupture was considered to have occurred at a fragile site due to circulatory disturbance of the gastric wall.
Article
All reported cases of spontaneous rupture of the stomach in adults have been reviewed and an additional case is described. Most patients with gastric rupture have been females, and gastric dilatation from a variety of causes is an important etiological factor. The rupture occurs most frequently along the lesser curvature and the prognosis is poor. The over-all mortality rate is 85 percent and can only be improved by prompt recognition of this condition and early operative intervention. The following findings should suggest the diagnosis of spontaneous gastric rupture: (1) Abdominal symptoms consistent with an acute abdominal catastrophe; (2) marked abdominal distention; (3) shock; and (4) subcutaneous emphysema about the neck.
Article
Full textFull text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (253K), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References. 324 Selected References These references are in PubMed. This may not be the complete list of references from this article. LADKIN RG, DAVIES JNP. Rupture of the stomach in an African child. Br Med J. 1948 Apr 3;1(4552):644–644. [PMC free article] [PubMed]
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