Fatal Acute Hemorrhagic Bowel Infarction Caused by Mesenteric Venous Thrombosis

Abstract

Acute mesenteric venous thrombosis (MVT) is a rare, but life-threatening medical phenomenon. MVT is normally characterized by insidious onset, with nonspecific signs and symptoms. A high index of clinical suspicion is required for diagnosis, and emergency surgery is necessary to optimize the chances of patient survival, especially in the people aged more than 70 years. Surprisingly, based on my review of the literature, no fatal acute MVT case has been reported in the forensic literature. All reported such cases have been documented in medical literature, and most of them have been associated with underlying risk factors for venous thrombosis, such as hypercoagulable state, certain cancers, and stasis of the blood flow. Here, I report the case of a sudden unexpected death due to extensive intestinal ischemia and infarction with massive abdominal hemorrhage caused by acute MVT in a 72-year-old man without known underlying risk factors.KEYWORDS: forensic science, forensic pathology, embolism, intestinal gangrene, vascular occlusion, medico-legal death, sudden unexpected death, thrombosis Mesenteric ischemia (MI) arises from a highly complex heterogeneous group of disorders that result in insufficient blood supply to the intestine, causing extensive irreversible bowel infarction and eventual death. Although a rarely occurring event, MI is a lifethreatening condition that is well understood among physicians who treat patients with acute abdominal disorders. A highly lethal condition that is difficult to diagnose, only one-third of patients with acute mesenteric ischemia (AMI) were correctly identified before surgical intervention or death (1,2). AMI requires emergency surgical treatment, with mortality rates that range from 60% to 80% (3,4). Avoiding delay in diagnosis and treatment remains the greatest challenge to reducing the high mortality rate associated with this condition (5). Surprisingly, based on my review of the literature, no such case has been reported in the forensic literature. All reported such cases have been documented in the medical literature, and most of them have been associated with underlying risk factors for venous thrombosis, such as hypercoagulable state, certain cancers, and stasis of the blood flow. Here, I report the case of a sudden unexpected death due to AMI with massive abdominal hemorrhage caused by acute mesenteric venous thrombosis in a 72-year-old man without known underlying risk factors. Case ReportA 72-year-old man was found dead lying on a sofa in his house by his wife and son who had returned home in the evening. According to information obtained from the deceased's relatives, the deceased was diagnosed with hypertension 5 years earlier and he irregularly complied with his prescribed antihypertensive therapy. Approximately 3 days before his death, he complained of intermittent abdominal discomfort and pain. He was not able to eat food as usual, and he had occasional nausea, vomiting, and diarrhea. He as well as his family, had no significant previous medical histo...

Developing and validating a nomogram for early predicting the need for intestinal resection in pediatric intussusception

“…( 29 , 30 ). The association between higher D-dimer level and intestinal ischemia has been reported previously ( 26 , 29 , 31 ). Our study likewise demonstrated that D-dimer had a significant positive correlation with intestinal resection (OR = 1.128; 95% CI, 1.005–1.267; p = 0.040) in univariable analysis, whereas no significant difference was observed in the multivariate analysis.…”