Sudden and unexpected deaths due to non-traumatic abdominal disorders: A forensic perspective. (July 2022) - Galante, Nicola
Abstract: Sudden and unexpected deaths due to non-traumatic abdominal disorders are a disregarded topic in the forensic field. These conditions are very heterogenous, accounting for 1–5% of sudden deaths. Specifically, acute gastrointestinal hemorrhages, bowel obstructions, liver cirrhosis, and necrotizing pancreatitis are frequently reported, whereas there are also unusual conditions which deserve careful analysis. Furthermore, the postmortem examinations of such disorders are not straightforward in the forensic setting since advanced putrefaction of the body, alleged medical malpractice, or the absence of any medical records could complicate autopsy procedures. Thus, the use of forensic histopathology, toxicology, microbiology, and postmortem radiology may help the pathologists to identify the abdominal cause of death. In this paper, the authors aim to discuss most of congenital and acquired abdominal conditions that have resulted in sudden and unexpected deaths. Hence, the discussion of the pathological features of each abdominal organ or system is prefaced with practical examples from caseworks of the Milan Institute of Legal Medicine. However, this paper also shows an extensive literature review with selected medicolegal articles to detailly describe the lethal mechanisms related to each condition, along with any associated risk factors or other diseases. Finally, each section shows a focus on either novel forensic approach (when available) or medicolegal implications, such as the use of postmortem radiology, peculiar histopathologic findings, or allegations in medical malpractices. Highlights: Spontaneous abdominal disorders account for 1–5% of sudden and unexpected deaths. Gastrointestinal bleedings, and acute peritonitis are typical causes of sudden deaths. Rare causes include sclerotizing peritonitis and spontaneous retroperitoneal bleedings. Postmortem radiology shows a high diagnostic specificity, but a low sensitivity for such disorders. Histopathology is always required to better define the macroscopic findings.