Gastric ischemia as an under-reported cause of death in older people.

IF 1.5 4区 医学 Q2 MEDICINE, LEGAL
Forensic Science, Medicine and Pathology Pub Date : 2025-03-01 Epub Date: 2024-05-28 DOI:10.1007/s12024-024-00840-5
Maria Paola Bonasoni, Filippo Pirani, Federica Grimaldi, Paolo Fais, Arianna Giorgetti, Susi Pelotti
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引用次数: 0

Abstract

Acute gastric ischemia is a rare condition due to the rich vascular supply of the stomach. Here we present a case of fatal gastric ischemia associated with bowel ischemia, only diagnosed at autopsy, which was requested for the suspicion of medical liability. A complete post-mortem examination was conducted, along with a macroscopic analysis of the superior mesenteric artery and detailed histological analyses. Past clinical data was also reviewed. The macroscopic blackish discoloration of the stomach and the bowel, coupled with the presence of neutrophils in the mucosa and submucosal non-occlusive thrombi, were consistent with gastric and bowel ischemia, despite the presence of confounding putrefactive changes. The unique aspect of this case resides in the ante-mortem peculiar vascularization of the stomach, supplied by small collateral vessels. No mechanical occlusion was identified, and the cause of the ischemia was deemed as non-occlusive, likely due to systemic hypoperfusion. The analysis of clinical data and documentation of associated comorbidities are strongly recommended, especially when a rare cause of death is suspected. With the aging population, especially among women, and the prevalence of risk factors, the forensic pathologist could increasingly encounter rare cases of gastric ischemia.

Abstract Image

胃缺血是未被充分报告的老年人死亡原因。
由于胃部血管供应丰富,急性胃缺血是一种罕见病症。在此,我们介绍一例致命的胃缺血伴肠缺血病例,该病例在尸检时才被确诊,而尸检是出于对医疗责任的怀疑而要求进行的。我们进行了全面的尸检,并对肠系膜上动脉进行了宏观分析和详细的组织学分析。同时还审查了以往的临床资料。胃和肠道的宏观变色呈黑色,粘膜上有中性粒细胞,粘膜下有非闭塞性血栓,尽管存在腐败性变化的混杂因素,但与胃和肠道缺血一致。该病例的独特之处在于死前胃部的特殊血管化,由小的侧支血管供应。没有发现机械性闭塞,缺血原因被认为是非闭塞性的,很可能是由于全身灌注不足造成的。强烈建议对临床数据进行分析,并记录相关的合并症,尤其是在怀疑死因罕见的情况下。随着人口老龄化,尤其是女性人口老龄化,以及危险因素的普遍存在,法医病理学家可能会越来越多地遇到罕见的胃缺血病例。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Forensic Science, Medicine and Pathology
Forensic Science, Medicine and Pathology MEDICINE, LEGAL-PATHOLOGY
CiteScore
3.90
自引率
5.60%
发文量
114
审稿时长
6-12 weeks
期刊介绍: Forensic Science, Medicine and Pathology encompasses all aspects of modern day forensics, equally applying to children or adults, either living or the deceased. This includes forensic science, medicine, nursing, and pathology, as well as toxicology, human identification, mass disasters/mass war graves, profiling, imaging, policing, wound assessment, sexual assault, anthropology, archeology, forensic search, entomology, botany, biology, veterinary pathology, and DNA. Forensic Science, Medicine, and Pathology presents a balance of forensic research and reviews from around the world to reflect modern advances through peer-reviewed papers, short communications, meeting proceedings and case reports.
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