title: Two forensic autopsy cases of death due to upper gastrointestinal hemorrhage: a comparison of postmortem computed tomography and autopsy findings.
abstract: In this report, we describe two autopsy cases of death due to upper gastrointestinal hemorrhage (Case 1: gastric ulcer, Case 2: aortoduodenal fistula). Postmortem computed tomography (CT) images from both cases revealed pooling of gastric fluid, which contained high attenuation areas, although these images also mirrored the different sources of the gastrointestinal hemorrhage. Fluid collection was observed in the small intestine for both cases, although the high attenuation areas were only remarkable in Case 2. The autopsy in Case 1 revealed a peptic ulcer, with small vessels exposed on the surface of the ulcer. Melena was also observed throughout the intestine, although clotting was only observed inside the stomach. The autopsy in Case 2 revealed diffuse massive clotting from the stomach to the upper portion of the ileum, which was due to a primary aortoduodenal fistula. Given our autopsy findings, the extent of the high attenuation areas in the digestive tract during postmortem CT scanning may be correlated with the speed of the gastrointestinal hemorrhage before death. Carefully evaluating the radiodensity of the gastrointestinal contents during postmortem CT scanning may indicate the primary site of the hemorrhage before the autopsy, thereby facilitating the accurate identification of the cause of death during forensic autopsy.
authors.affiliation: Tokyo Medical Examiner's Office, Tokyo Metropolitan Government, Japan. Electronic address: hideto-@qk9.so-net.ne.jp.
authors.forename: Hideto
authors.initials: H
authors.lastname: Suzuki
authors.affiliation: Tokyo Medical Examiner's Office, Tokyo Metropolitan Government, Japan.
authors.forename: Iwao
authors.initials: I
authors.lastname: Hasegawa
authors.affiliation: Tokyo Medical Examiner's Office, Tokyo Metropolitan Government, Japan.
authors.forename: Norio
authors.initials: N
authors.lastname: Hoshino
authors.affiliation: Tokyo Medical Examiner's Office, Tokyo Metropolitan Government, Japan.
authors.forename: Tatsushige
authors.initials: T
authors.lastname: Fukunaga
mesh_terms: D000368:Aged; D001018:Aortic Diseases / Q000150:complications; D001344:Autopsy; D002423:Cause of Death; D003933:Diagnosis; D004378:Duodenal Diseases / Q000150:complications; D049429:Forensic Pathology; D006471:Gastrointestinal Hemorrhage / Q000473:pathology*; D006801:Humans; D007412:Intestinal Fistula / Q000150:complications; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000473:pathology; D013276:Stomach Ulcer / Q000150:complications; D014057:Tomography, X-Ray Computed; D016157:Vascular Fistula / Q000150:complications
keywords: Forensic autopsy; Gastrointestinal hemorrhage; Postmortem computed tomography