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

Abstract

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.

Sudden Death Due to Acute Pancreatitis

“…Therefore, variations in the bile duct/pancreatic duct anatomy can potentially be a factor in the development or severity of gallstone pancreatitis. In the forensic setting, however, acute pancreatitis is most commonly seen in the context of alcoholism, either alone or superimposed on chronic pancreatitis (4, 25, 26). In part, this is due to the inherent selection bias of alcohol-related deaths frequently falling under ME/C jurisdiction.…”