Rapid death following undiagnosed stercoral perforation in a chronic opioid user. (February 2020)

• Record Type: Journal Article
• Authors: Heimer, Jakob; Tappero, Carlo; Fliss, Barbara; Meixner, Eva
• Is Part Of: Legal medicine. Volume 42(2020)
• Publication Date: 2020-02
• Subjects: Opioid abuse -- Constipation -- Stercoral perforation -- Peritonitis -- Postmortem computed tomography; Medical jurisprudence -- Periodicals; Forensic Medicine -- Periodicals; Médecine légale -- Périodiques; Medical jurisprudence; Periodicals; 614.1
• DOI: 10.1016/j.legalmed.2019.101644
• Languages: English
• ISSNs: 1344-6223

Abstract

Highlights: A fatal in hospital stercoral perforation in a chronic opioid user is reported. A radiograph taken 16 h before death showed no signs of perforation. To exclude medical malpractice, a forensic investigation was ordered. Early clinical cross-sectional imaging could improve the diagnosis of stercoral perforation. Abstract: A case of rapid demise following an undiagnosed stercoral perforation is reported. A 57-year-old woman on chronic opioid replacement therapy presented with constipation and abdominal pain to the hospital. Following an unremarkable abdominal radiograph and admission for laxation and pain therapy, she was found dead only 18 h later. To exclude medical malpractice, a postmortem investigation was ordered. Postmortem computed tomography and autopsy revealed fatal fecal peritonitis based on a stercoral perforation of the rectosigmoid, which had been undiagnosed. This report highlights the need for early cross-sectional imaging and contributes to the data collection concerning this ever-growing, vulnerable group of patients undergoing opioid replacement.