Sudden unexpected death due to strangulated inguinal hernia

Abstract

Sudden unwitnessed, unexpected deaths when the bodies are found in public places require a complete and meticulous medicolegal autopsy to ascertain the cause and manner of death to avoid further unnecessary investigations by the legal authorities. Such deaths attributed to gastrointestinal causes at autopsy are relatively uncommon. We report a case of sudden unexpected death due to strangulated inguinal hernia in a 60-year-old man. The body was discovered in a public area near a place of worship. The present case illustrates a potentially preventable sudden unexpected death due to a surgically correctable gastrointestinal condition. In the present case, the individual feared being hospitalised for treatment of his scrotal swelling with potential surgery and the eventual loss of daily income. In our opinion, such apprehensions may have delayed the potentially life-saving hospital surgical intervention in the individual.

Gastrointestinal causes of sudden unexpected death: A review

“…In this case, the child had presented to the hospital with acute abdominal pain and vomiting. 18 In addition to the diaphragmatic hernia, the autopsy revealed an associated gastric volvulus with necrosis 14 and rupture. 18 Navarro-Crummenauer et al 19 describe a case of death due to previously undiagnosed congenital diaphragmatic hernia in a 14-month-old child wherein the autopsy revealed herniation of the terminal ileum, caecum, colon and greater omentum into the left thoracic cavity causing significant compression of the left lung.…”

“…We would like to thank the editor (Diana Brahams) and publisher (SAGE Publishing) of Medico-Legal Journal for permitting us to reuse the images (Figures 1 to 3) that were originally published in Menezes et al 14…”

“…Menezes et al 14 describe a case of potentially preventable sudden unexpected death due to a gastrointestinal cause wherein a 60-year-old was found lying dead near a place of worship. Following an autopsy, the cause of death was opined as that consequent to small intestinal strangulation caused by herniation of a loop of the small intestine in a right-sided inguinal hernial sac (Figures 1 to 3).…”

“…Following an autopsy, the cause of death was opined as that consequent to small intestinal strangulation caused by herniation of a loop of the small intestine in a right-sided inguinal hernial sac (Figures 1 to 3). 14 In such a case, the mechanisms of death may be quite complex and include fluid and electrolyte imbalance, intestinal haemorrhagic infarction and marked translocation and systemic exposure to aerobic and anaerobic bacteria with their associated toxins.…”

“…This article discusses the various congenital and acquired gastrointestinal conditions 1,2,4–63 that have resulted in sudden unexpected death. The possible lethal mechanisms behind each condition, along with any associated risk factors or secondary diseases, are described in detail.…”