Resuscitation artefact confirmed by postmortem angiography. Case report

Abstract

Postmortem resuscitation artefacts are often encountered in the autopsy practice. During chest compression that is an essential component of resuscitation, thorax injuries including rib and sternum fractures and anterior mediastinal bleeding are often observed. Massive bleeding that develops as a result of a hepatic rupture is a rare complication of resuscitation. A 23 year-old woman attempted suicide by taking drug overdose in a hospital toilet. During autopsy we found fractures in the 1-6 th left ribs and 3 rd right rib in the midclavicular line, hemoperitoneum (1300 ml) and a rupture of 0.5 cm in depth and 8 cm in length in the left posterior lobe of the liver with an a hemorrhagic area of 4x2 cm in the left lobe neighbouring the diaphragm. A postmortem angiography found intraabdominal vessels to be intact and identified the source of the bleeding as being the liver rupture. The toxicological analysis identified drugs used in resuscitation and high levels of sotalol (4090 ng/mL) and flecainide (4350 ng/mL) in the blood. The underlying cause of death was considered to be drug intoxication. Liver rupture and bleeding caused by it is rarely seen as a complication of resuscitation. We consider that regional angiography will highly contribute to autopsies in which the source of bleeding is investigated, since it is easily implemented, inexpensive and practical.