Lethal mechanisms in gastric volvulus

Omond, Kimberley J.; Byard, Roger W.

doi:10.1177/0025802416689764

Cited by 7 publications

(4 citation statements)

References 12 publications

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“…Medical episodes causing death may be directly related to underlying conditions such as epilepsy or aspiration of food (as in one of the reported cases) or volvulus in severe cerebral palsy, 18 or they may contribute to weakness and frailty, preventing self-extrication in cases of falls and wedging, as described above. Alternatively, a medical episode such as an acute myocardial infarct may be completely coincidental to other health problems and chair usage, as in two of the cases.…”

Section: Discussionmentioning

confidence: 93%

Deaths associated with wheelchairs

Byard

2021

Med Sci Law

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As lethal events associated with wheelchair use are poorly reported in the literature, a search was undertaken of the Forensic Science South Australia (FSSA), Australia, autopsy database over a 20-year period for all cases where individuals who were wheelchair bound were found dead either in or beside their chairs. There were 16 cases, ranging in age from 30 to 92 years ( M = 58.6 years) and with a male-to-female ratio of 9:7. There were six accidents that involved burns, asphyxia, a fall and impact with a vehicle; three suicides that involved drowning and asphyxia; a single homicide involving drowning; a single undetermined case; and five cases due to medical conditions such as cerebral palsy with choking, ischaemic heart disease and pulmonary thromboembolism. Individuals who use wheelchairs may die from a wide variety of both unnatural and natural causes. Wheelchair users may be predisposed to specific types of accidents because of significant underlying physical impairment or serious diseases that may limit their ability either to move away from danger or to perform self-rescues. Morbidity and mortality associated with underlying medical conditions may be contributed to by the structure, stability and motility of wheelchairs.

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Section: Discussionmentioning

confidence: 93%

Deaths associated with wheelchairs

Byard

2021

Med Sci Law

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“…life-threatening mechanisms have been postulated including increased intrathoracic pressure secondary to closed loop obstruction in the chest leading to cardiorespiratory compromise from compression of the heart (with reduced right ventricular preload and resultant hemodynamic instability) and lungs (leading to respiratory failure). 10,11 The classical presentation of acute gastric volvulus was first described in 1904 comprising of Borchardt's triad of acute epigastric pain, unproductive retching, and inability to pass a nasogastric tube. 12 Other recognized symptoms include hematemesis and hiccups.…”

Section: Discussionmentioning

confidence: 99%

“…8 9 Alternate life-threatening mechanisms have been postulated including increased intrathoracic pressure secondary to closed loop obstruction in the chest leading to cardiorespiratory compromise from compression of the heart (with reduced right ventricular preload and resultant hemodynamic instability) and lungs (leading to respiratory failure). 10 11…”

Section: Discussionmentioning

confidence: 99%

Management and Outcomes in Gastric Volvulus: A Tiered Approach

Askari

Tezcan

Patel

et al. 2022

Digestive Disease Interventions

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Introduction Gastric volvulus is a rare yet life-threatening condition requiring urgent attention. In this case series and literature review, we present the difficulties in management and outcome in patients with gastric volvulus and suggest a tiered framework to guide management. All consecutive cases at a single institution presenting between January 1, 2010, and June 30, 2020, were included. Chi-squared analyses were undertaken to compare outcomes across different groups. A total of 48 patients presented with gastric volvulus; the median age was 78 years (interquartile range [IQR]: 69–84) and 70.8% were female. Most patients had an ASA score of III (n = 19/48, 39.6%) or IV (n = 14/48, 29.2%). In total, 62.5% (n = 30/48) underwent laparoscopic surgery and mesh was used in 40.0%. Eighteen patients (37.5%) were not suitable candidates for surgery or declined surgery. The median length of stay in those undergoing surgery was 4 days (IQR: 2–6). The complication rate in this cohort was 26.7% (n = 8/30). Of these eight patients, four had postoperative nausea, and four others suffered from pneumothorax, wound hematoma, intra-abdominal bleeding, or intra-abdominal collection. The patient who had a serious intra-abdominal bleed returned to operating room and required blood transfusions on day 1 postsurgery. The readmission rate in the surgery group was 6.6% (n = 2/30), both of who had prolonged nausea and were treated symptomatically. The overall 30-day morality in the surgical group was 3.3%. Over a follow-up period of 37 months, 10.0% had a recurrence of hernia, all of who were managed conservatively. Gastric volvulus is a surgical emergency that is associated with a high rate of morbidity and mortality. A tiered treatment algorithm based on urgency can help deliver timely treatment and standardize care. One in 10 patients post–gastric volvulus repair will have recurrence of para-oesophageal hernia but can be treated conservatively.

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“…Omond and Byard report an autopsy case of death resulting from an acute gastric volvulus in a 55-yearold woman. 58 The lethal mechanisms in such cases of acute gastric volvulus include peritonitis resulting from gastric perforation due to gastric wall necrosis from a compromised gastric blood supply and overwhelming distension of the stomach from swallowed air and fluid, hypovolaemic shock resulting from obstruction or compromised respiration resulting from significant left lung compression due to the gastric volvulus pushing the left diaphragm upwards. 58…”

Section: Volvulusmentioning

confidence: 99%

Gastrointestinal causes of sudden unexpected death: A review

et al. 2017

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Gastrointestinal conditions are a less common cause of sudden unexpected death when compared to other conditions such as cardiovascular conditions, but they are equally important. Various congenital and acquired gastrointestinal conditions that have resulted in sudden unexpected death are discussed. The possible lethal mechanisms behind each condition, along with any associated risk factors or secondary diseases, have been described. Through this article, we aim to highlight the need for physicians to prevent death in such conditions by ensuring that subclinical cases are diagnosed correctly before it is too late and by providing timely and efficacious treatment to the patient concerned. In addition, this review would certainly benefit the forensic pathologist while dealing with cases of sudden unexpected death due to gastrointestinal causes. This article is a review of the major gastrointestinal causes of sudden unexpected death. In addition, related fatal cases encountered occasionally in forensic autopsy practice are also included. There are several unusual and rare causes of life-threatening gastrointestinal bleeding that may lead to sudden unexpected death to cover all the entities in detail. Nevertheless, this article is a general guide to the topic of gastrointestinal causes of sudden unexpected death.

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Lethal mechanisms in gastric volvulus

Cited by 7 publications

References 12 publications

Deaths associated with wheelchairs

Deaths associated with wheelchairs

Management and Outcomes in Gastric Volvulus: A Tiered Approach

Gastrointestinal causes of sudden unexpected death: A review

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