title: Cause of internal hemorrhage determined after exhumation: Report of one case.
abstract: A 36-year-old woman consulted the medical emergency unit of a private health center for abdominal pain and gastroenteritis of 5 days duration. Acute right pyelonephritis was diagnosed. Five hours after admission she became unconscious in a state of clinical shock. She was transferred to an intensive care unit but resuscitation attempts were unsuccessful and she died 3h later. Three days after death, she was buried in the family vault. Five days after the burial, her husband lodged a complaint with the public prosecutor because he had not received a clear explanation from the physicians concerning the cause of his wife's death. After analysis of the medical records of the deceased by two forensic pathologists, a medicolegal autopsy was ordered by the public prosecutor. The corpse was exhumed and autopsy performed 9 days after death. Massive hemoperitoneum was diagnosed with a macroscopically ruptured subcapsular hematoma. Pathological study confirmed acute right pyelonephritis and demonstrated the precise cause of the hemorrhage: rupture of the hepatic artery at the hilar part, following infectious arteritis which was probably secondary to the acute pyelonephritis. To the best of our knowledge, this is the first published report of such a case.
authors.affiliation: Service de Médecine Légale, CHU Toulouse-Rangueil, 1 Avenue Professeur Jean Poulhès, 31059 Toulouse Cedex 9, France. fabded2@hotmail.com
authors.forename: Fabrice
authors.initials: F
authors.lastname: Dedouit
authors.forename: Marie-Dominique
authors.initials: MD
authors.lastname: Piercecchi-Marti
authors.forename: Georges
authors.initials: G
authors.lastname: Leonetti
authors.forename: Daniel
authors.initials: D
authors.lastname: Rougé
authors.forename: Norbert
authors.initials: N
authors.lastname: Telmon
mesh_terms: D000208:Acute Disease; D000328:Adult; D001170:Arthritis, Infectious / Q000473:pathology; D049249:Exhumation; D005260:Female; D049429:Forensic Pathology; D006406:Hematoma / Q000473:pathology; D006465:Hemoperitoneum / Q000473:pathology; D006470:Hemorrhage / Q000209:etiology*; D006499:Hepatic Artery / Q000293:injuries* / Q000473:pathology; D006801:Humans; D010532:Peritoneal Diseases / Q000209:etiology*; D011704:Pyelonephritis / Q000175:diagnosis*; D012421:Rupture