Intestinal obstruction as a cause of death in the mentally disabled

Abstract

Two cases of intestinal obstruction in the mentally disabled are reported. The first case concerns 61-year-old oligophrenic woman who resided in a nursing home, where she was found hypotensive and unresponsive. Upon opening the peritoneal cavity at autopsy, extremely dilated (measuring on average 12 cm in diameter) loops of the colon emerged- they compressed the small intestine and other intraperitoneal organs, lifting both hemidiaphragms deep into the pleural cavity. Lodged firmly into the rectum, a partly disintegrated sanitary pad was found. In the second case, young man with Down syndrome was found dead in his room in a nursing facility. At autopsy, a massively dilated stomach and intestinal loops emerged, interposing one of the loops between the liver and right hemidiaphragm (pushing it to the 3rd intercostal space). This was caused by a volvulus - the cecum, the entire ascending colon and hepatic flexure were gangrenous, dilated (the maximum diameter was 15 cm) and twisted in a full circle around the mesenteric attachment. There were no signs of colon perforation. In both cases, intellectual disability was at the core of poor communication and delayed medical treatment, which led to a fatal outcome. Caregivers must be trained to recognize distress in the mentally disabled, especially since the symptoms and signs of gastrointestinal diseases may be subtle, or at least less recognizable. By performing careful physical examination medical staff should search more cautiously for these signs. Any suspicion of mistreatment or neglect of the mentally impaired requires a medico-legal investigation and autopsy.

Surgery for acute abdomen in adult patients with severe motor and intellectual disabilities

“…For early diagnosis and treatment, caregivers should be trained to recognize signs of distress in their charges, seek immediate medical care, and not hesitate to consult a physician when in doubt. It is also important that medical staff watch for symptoms and signs by performing a careful physical examination especially because these signs and symptoms may be more subtle or less recognizable in patients with MID than in other patients [ 5 ]. In our study, the postoperative complication rate was 28.6%, and the in-hospital mortality rate was 5.7%.…”

Constipation in autistic people and people with learning disabilities

“…In another, a young man showing unusual behaviour for several days, possibly experiencing discomfort and pain, and unable to communicate this distress to others, died from constipation complications. 26 A further two cases describe sudden death in two women, one with ASC and one with an LD. 27 Both suffered from chronic constipation.…”

Definitions, signs, and symptoms of constipation in people with severe or profound intellectual disabilities: A systematic review

“…Also, it has been observed that a higher frequency of convulsions in persons with epilepsy may be related to constipation ( Bragg et al., 1994 ). In fact, constipation can be a serious problem resulting in fatal intestinal obstruction due to missed clinical symptoms ( Jancar and Speller, 1994 ; Patja et al., 2001 ), and these may cause death among individuals with severe or profound intellectual disabilities ( Cvetković et al., 2019 ).…”