Unexpected sudden death due to a spontaneous rupture of a gastric dissecting aneurysm: an autopsy case suggesting the importance of the double-rupture phenomenon.
Gastric dissecting aneurysm is a very rare lesion with a potential risk of fatal rupture. Differentiating this from a traumatic lesion may be important in forensic casework. We report an autopsy case of sudden death due to a clinically overlooked spontaneous rupture of gastric dissecting aneurysm. A 91-year-old Japanese male visited a hospital with complaints of back pain and general fatigue, and then died at his home about 4 h later. Postmortem examination revealed massive hemoperitoneum and a subserosal hematoma originating from a vascular lesion at the lesser gastric curvature with a serosal tear. The histological findings were compatible with segmental arterial mediolysis (SAM). The pathological findings and clinical course suggested the possible 'double-rupture phenomenon' (delayed fatal rupture). This case suggested the importance of careful investigation such a vascular lesion in medico-legal practice, not only to differentiate from traumatic injury but also to investigate the process of dying.
Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, 545-8585 Osaka, Japan. legalmed@med.osaka-cu.ac.jp
Sayaka
S
Nishiyama
Bao-Li
BL
Zhu
Li
L
Quan
Kohei
K
Tsuda
Yasunobu
Y
Kamikodai
Hitoshi
H
Maeda
D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000150:complications* / Q000473:pathology; D001344:Autopsy; D001416:Back Pain / Q000209:etiology; D003645:Death, Sudden / Q000209:etiology* / Q000473:pathology; D005221:Fatigue / Q000209:etiology; D006465:Hemoperitoneum / Q000209:etiology* / Q000473:pathology; D006801:Humans; D008297:Male; D012307:Risk Factors; D012422:Rupture, Spontaneous; D013152:Splanchnic Circulation; D013270:Stomach / Q000098:blood supply*