title: Wischnewski ulcers and acute pancreatitis in two hospitalized patients with cirrhosis, portal vein thrombosis, and hypothermia.
abstract: Accidental hypothermia has been described in the forensic literature but reports of occurrence in hospitalized patients are rare. Associated anatomic lesions include acute hemorrhagic pancreatitis and characteristic acute gastric ulcers termed Wischnewski ulcers. We report here two patients with cirrhosis and ascites; one also had hepatocellular carcinoma. Portal vein thrombosis, acute hemorrhagic pancreatitis and Wischnewski ulcers were present in both. The clinical records documented hypothermia that progressed over several days. Temperature nadirs of 31.0 degrees C (87.8 degrees F) and 32.2 degrees C (90.0 degrees F) were recorded in each patient, respectively, one day before death, although each transiently reached temperatures that did not register on standard monitoring devices. This is the first report that chronicles antemortem body temperatures in hypothermic patients with Wischnewski ulcers and pancreatitis at autopsy. Also, the association of these findings with portal vein thrombosis and cirrhosis has not been previously described. We discuss this constellation of findings with regard to possible mechanistic interrelations.
authors.affiliation: Dade County Medical Examiner Office, Miami, FL, USA.
authors.forename: D A
authors.initials: DA
authors.lastname: Wolf
authors.forename: J F
authors.initials: JF
authors.lastname: Aronson
authors.forename: S
authors.initials: S
authors.lastname: Rajaraman
authors.forename: S P
authors.initials: SP
authors.lastname: Veasey
mesh_terms: D000208:Acute Disease; D001831:Body Temperature; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000473:pathology; D017809:Fatal Outcome; D005260:Female; D005554:Forensic Medicine; D006760:Hospitalization; D006801:Humans; D007035:Hypothermia / Q000150:complications* / Q000473:pathology; D008103:Liver Cirrhosis / Q000150:complications* / Q000473:pathology; D008113:Liver Neoplasms / Q000150:complications / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology* / Q000473:pathology; D011169:Portal Vein; D013276:Stomach Ulcer / Q000209:etiology* / Q000473:pathology; D020246:Venous Thrombosis / Q000150:complications* / Q000473:pathology