Diagnostic Dilemma of Sudden Deaths Due to Acute Hemorrhagic Pancreatitis

Tümer, Ali Rıza; Dener, Cenap

doi:10.1111/j.1556-4029.2006.00316.x

Cited by 15 publications

(21 citation statements)

References 14 publications

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“…Interestingly, first episodes of AP, which have higher mortality rates than multiple episodes of AP, [2] was pathologically depicted in this case. Pulmonary edema, which has been considered a major organ failure and an early cause of death in individuals with SAP in both clinical- and autopsy-based studies, [2,5,31–33] was also found in this case. SAP-induced severe systemic inflammatory response, [32] diabetic ketoacidosis, [34] fluid overload, and/or blood transfusion [35] could be responsible for such a phenomenon.…”

Section: Discussionsupporting

confidence: 53%

Severe acute hemorrhagic pancreatitis secondary to cholelithiasis as a rare cause of sudden unexpected death in medico-legal case

Srettabunjong

Limgitisupasin²

2016

Medicine

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Introduction:Acute pancreatitis (AP) is an uncommon disease with a wide clinical course varying from mild and self-limiting to severe with eventual death. However, death caused by AP is rare. Most cases of AP reported in the English-language literature are based on clinical data; few are medico-legal studies.Case presentation:The author recently experienced a case of sudden unexpected death in a young man caused by extensive severe hemorrhagic AP secondary to cholelithiasis, not chronic alcoholism, which is a much more prominent etiology of AP in medico-legal perspectives. The deceased had complained of dizziness, nausea, and fatigue without significant abdominal pain for about 1 week and received some home medications for symptomatic treatment including an antibiotic drug from a clinic just 2 days prior to his death. He had complained of lower extremity weakness, intense thirst, and subsequently collapsed and was brought to a nearby hospital where he was pronounced dead shortly after his admission following unsuccessful advanced cardiopulmonary resuscitation attempts.Conclusion:This case is herein reported with an extensive review of the pertinent literature to highlight the findings of the case and raise awareness within the medico-legal profession and also the medical profession.

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Section: Discussionsupporting

confidence: 53%

Severe acute hemorrhagic pancreatitis secondary to cholelithiasis as a rare cause of sudden unexpected death in medico-legal case

Srettabunjong

Limgitisupasin²

2016

Medicine

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“…The haemorrhage was confined to the head of the pancreas in three cases and involved the whole body in nine. While pulmonary congestion and haemorrhages were also found, no association between the two was established 22. Our series enrolled only sudden nocturnal death, hence dealing with a more specific population.…”

Section: Discussionmentioning

confidence: 96%

A case control study on autopsy findings in sudden unexplained nocturnal death syndrome

Gervacio-Domingo

Lim²,

Reganit

et al. 2014

Heart Asia

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Aim Sudden unexplained nocturnal death syndrome (SUNDS) has been linked to the Brugada syndrome. In some places, acute haemorrhagic pancreatitis is widely held to cause it. We conducted a systematic, controlled autopsy study on Filipino SUNDS victims to rule out structural heart findings as well as acute haemorrhagic pancreatitis as causes. Methods and results A case control autopsy study was conducted comparing SUNDS victims between 18 and 50 years of age who died within 1 h of symptom onset with age-and gender-matched controls. There were 24 SUNDS (mean age 34.5 years) and 24 controls (mean 32.7 years). The autopsy incidence of structural heart disease was 8.3% (95% CI (1% to 27%)) and focal pancreatic haemorrhage was 4.17% (95% CI (0.1% to 20%)) but zero for true acute haemorrhagic pancreatitis among SUNDS victims. Autopsy findings in SUNDS versus controls were not significantly different from each other, showing no diagnostic abnormality in any of the organs. There was no significant difference in the incidence of acute haemorrhagic pancreatitis in both the SUNDS and control groups. We did not find fetal dispersion of the atrioventricular (AV) node, sclerosis or fibrosis of the AV conduction system, in a substudy of SUNDS cases. Conclusions We have shown that there is no significant difference in the overall autopsy findings between SUNDS and controls. Autopsy findings were normal in 70% of SUNDS; no cardiac structural pathology was found in 87% of cases. Haemorrhagic pancreatitis is the cause of death in a minority of SUNDS. The cardiac conduction system is normal in a subgroup of SUNDS studied.

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“…A range of esophageal causes of sudden death have been recorded [310] including in relation to megaesophagus [311]; esophageal polyps [312]; hemorrhage from varices, vascular abnormalities or Mallory-Weiss tears, and rupture, which may be spontaneous (Boerhaave syndrome) [313] or secondary to conditions such as Barrett's esophagus [314]. Within the abdominal cavity, acute hemorrhage from peptic ulcer or dissecting aneurysm [281], perforated peptic ulcer [20,315], rupture of the stomach [316], perforated colon (diverticular or stercoral from constipation [317]), intestinal obstruction, intussception [318], mesenteric ischemia, acute pancreatitis [319,320], acute cholecystitis and fatty liver may be responsible for sudden death [321]. However, it must be remembered that esophageal and gastric rupture can occur due to resuscitative techniques (including the Heimlich manoeuver) [322][323][324] and intussception can be a terminal event not related to the cause of death [325].…”

Section: Gastrointestinal Pathologies That May Present As Sudden Deathmentioning

confidence: 99%

Sudden adult death

Langlois

2009

Forensic Sci Med Pathol

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In the investigation of sudden death in adults, channelopathies, such as long QT syndrome, have risen to the fore in the minds of forensic pathologists in recent years. Examples of these disorders are touched upon in this review as an absence of abnormal findings at postmortem examination is characteristic and the importance of considering the diagnosis lies in the heritable nature of these conditions. Typically, a diagnosis of a possible channelopathy is evoked as an explanation for a 'negative autopsy' in a case of apparent sudden natural death. However, the one potential adverse effect of this approach is that subtle causes of sudden death may be overlooked. The intention of this article is to review and discuss potential causes of sudden adult death (mostly natural) that should be considered before resorting to a diagnosis of possible channelopathy. Nonetheless, it becomes apparent that many of the potential causes of sudden death can have a genetic basis. Thus, it becomes an important consideration that there may be a genetic basis to sudden death that extends beyond the negative autopsy.

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Diagnostic Dilemma of Sudden Deaths Due to Acute Hemorrhagic Pancreatitis

Cited by 15 publications

References 14 publications

Severe acute hemorrhagic pancreatitis secondary to cholelithiasis as a rare cause of sudden unexpected death in medico-legal case

Severe acute hemorrhagic pancreatitis secondary to cholelithiasis as a rare cause of sudden unexpected death in medico-legal case

A case control study on autopsy findings in sudden unexplained nocturnal death syndrome

Sudden adult death

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