Cardiovascular disease is an important contributor to maternal mortality in both developing and developed countries. Systematic search for cardiac disease is usually not performed during pregnancy despite hypertensive disease, undiagnosed pulmonary hypertension and cardiomyopathies being recognized as major health problems in these settings. This article reported a 27-year-old female who was normal on clinical examination and basic investigations, and on an antenatal visit was found collapsed in the toilet of her house and was pronounced dead on admission to hospital. She was found to be in the 11th week of pregnancy and had no history of significant illness in the past. Autopsy did not reveal any obvious macroscopic pathology except for a significant amount of epicardial fat infiltrating into myocardium of right ventricle. Detailed histopathological examination of the heart demonstrated fibro-fatty replacement of the heart muscle. The cause of death was arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D). ARVC/D can cause unexpected sudden death during pregnancy. Therefore, it is recommended that an ECG and echocardiogram be included as screening tests during antenatal follow-up to minimize preventable cardiac deaths like ARVC/D.
This case report presents a case of domestic violence using an unusual approach to compel the wife to leave home in an attempt to continue an extramarital affair. The method used by the husband in this case is a herbal plant known as Dendrocnide sinuate or commonly known in Sri Lanka as 'gas kahambiliya' or 'Ma Ussa' which causes a severe dermatological reaction.
Aorto-oesophageal fistula is a life threatening condition in which there is an abnormal connection between the aorta and oesophagus, and is a rare complication of foreign body ingestion from which few patients survive. Classic presentation is with Chiari's triad of mid thoracic pain, sentinel arterial haemorrhage and massive exsanguination after a symptom free interval. A 36-year-old male was transferred to a tertiary care hospital with a history of epigastric pain and discomfort in his retro-sternal area. According to the history, he had ingested fish the previous day while consuming alcohol. He was treated for four days in the hospital, and discharged with a diagnosis of alcohol induced gastritis. He was re-admitted later the same day with an episode of haematemesis. However, investigations such as chest radiography and oesophagogastroduodenoscopy were not carried out. He developed massive haematemesis 12 hours later, and despite vigorous resuscitation and emergency surgery, he expired. Autopsy revealed an impacted fish bone at the junction of upper and middle third of the oesophagus creating a fistula tract from oesophagus to thoracic aorta which resulted in exsanguination, haemorrhagic shock and death. Even though mortality is very high, survival is possible with a high index of suspicion, early diagnosis and rapid surgical intervention. Autopsy findings, review of the literature and medico-legal aspects of possible medical negligence are discussed.
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