Resumo. Uma das principais funções da Medicina Legal (ML) é estabelecer a causa médica das mortes produzidas por violência. Entretanto, é possível que o legista não seja capaz de determiná-la ao não encontrar causa anatômica, patológica ou toxicológica que a justifique, permanecendo a mesma como indeterminada. Neste estudo foram avaliadas as causas indeterminadas de morte (CIM) no Instituto Médico Legal de Belo Horizonte (IML-BH) através do estudo retrospectivo dos relatórios de necropsias realizadas em 2008. As CIM constituíram quase um terço das 6.096 necropsias realizadas nesse ano. A causa da morte foi apenas indeterminada em 1.487casos, foi indeterminada per accidens em 217 óbitos e indeterminada per se em 76 necropsiados. Na maioria das CIM (63,31%) não houve atendimento médico previamente ao óbito e este grupo mostrou-se estatisticamente semelhante ao grupo de causas de morte naturais. Esses dados indicam que o número elevado de CIM foi decorrente da grande demanda do IML-BH para realizar exames em

Introduction: Dieulafoy’s lesion (DL) is occasioned by a tortuous, persistent and large caliber artery that emerges the mucosa from the submucosa of an organ, eventually triggering gastrointestinal bleeding in the presence of eroding factors of the mucosa and arterial wall. The presence of DL has been described in many anatomic topographies and although it predominates in the upper digestive tract, the presence of this lesion exactly in the major duodenal papilla is a rare event. Objective: to report a case of upper gastrointestinal bleeding secondary to a major duodenal papilla DL. Case report: a 72 year-old female, admitted to hospital care with a clinical history of two months continuous, painless melena, multiple previous blood transfusions and symptomatic anemia. She was referred by another health service with the diagnostic hypothesis of hemobilia, suggested by two previous esophagogastroduodenoscopies. Her abdominal ultrasound and arteriography were normal. A third esophagogastroduodenoscopy evidenced active bleeding in the duodenal major papilla, and after a carefully analysis a papillar DL was diagnosed. It was treated by endoscopy with adrenaline 1:10000 injection and thermocoagulation. Following this procedure she evolved with severe acute pancreatitis due to papillitis and need of intensive care unit admission. No rebleeding was detected and hospitalar discharge occurred twenty days after hospitalization. Conclusion: The localization of a DL at the major papilla is a rare event and acute pancreatitis is a complication related to its endoscopic treatment.