An unusual case showing fatal rupture of a gastric ulcer or gastromalacia? The importance/role of histology for differential diagnosis.
Gastromalacia is the acute autolytic erosion of the gastric wall. It generally occurs postmortem, and it appears as a slimy brownish black region of the wall which occurs principally in the gastric fundus. A 59-year-old woman died in the Emergency Department following a 2-day period of mild abdominal pain, vomiting, and diarrhea. A forensic autopsy was performed which revealed a rupture of the gastric fundus that had caused leakage of gastric content into the abdominal cavity. There was no macroscopic evidence of peritonitis, and the stomach wall adjacent to the rupture site showed marked thinning. The gross appearance was typical of gastromalacia. In contrast, histological observations revealed the presence of an ulcer at the site of perforation and a severe acute inflammatory reaction indicating a robust reaction with an antemortem rupture.
Institute of Public Health, Section of Legal Medicine, School of Medicine, Catholic University of the Sacred Heart, Largo Francesco Vito 1, Rome, 00168, Italy.
Fabio
F
De-Giorgio
Maria
M
Lodise
Vincenzo L
VL
Pascali
Antonio G
AG
Spagnolo
Ernesto
E
d'Aloja
Vincenzo
V
Arena
D015746:Abdominal Pain / Q000209:etiology; D001329:Autolysis; D003937:Diagnosis, Differential; D005260:Female; D049429:Forensic Pathology; D006801:Humans; D008875:Middle Aged; D010439:Peptic Ulcer Perforation / Q000175:diagnosis*; D011180:Postmortem Changes; D013270:Stomach / Q000473:pathology*; D013276:Stomach Ulcer / Q000150:complications*
artifacts; forensic autopsy; forensic pathology; forensic science; gastromalacia; histology; stomach ulcer