title: Cardioinhibitory reflex due to a karate kick: a case report.
abstract: This article describes the case of a 17-year-old adolescent boy who received a foot kick in the trunk area from an expert in karate. He presented with immediate cardiocirculatory arrest. After a prolonged resuscitation, he was transferred to a hospital where he died 5 days later without ever regaining consciousness. Postmortem investigations including autopsy, radiology, histology, toxicology, and postmortem chemistry were performed that showed signs of multiple organ failure, an acute hemorrhage in the region of the celiac plexus, and signs of medical resuscitation. No preexisting disease, particularly those concerning the heart, was objectified. The cause of death was attributed to multiple organ failure after a prolonged cardiocirculatory arrest. Concerning the origin of the cardiac arrest, 2 hypotheses were considered-a cardioinhibitory reflex and a cardiac contusion (commotio cordis). Because of the presence of traumatic lesions in the celiac plexus, the first hypothesis was finally submitted. This case is reported because rare cases of sudden death from celiac reflex are described in the literature where it is almost impossible to find references with accurate documentation. The presented case confirms the importance of detailed documentation of the circumstances and postmortem investigations to establish a diagnosis of death due to cardioinhibitory reflex.
authors.affiliation: From the *University Center of Legal Medicine Lausanne-Geneva, Lausanne, Switzerland; †Institute of Legal Medicine, University of Liège, Liège, Belgium; and ‡Department of Clinical Pathology, Geneva University Hospital, Geneva, Switzerland.
authors.forename: Sébastien
authors.initials: S
authors.lastname: de Froidmont
authors.forename: Johannes Alexander
authors.initials: JA
authors.lastname: Lobrinus
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Michaud
authors.forename: Cristian
authors.initials: C
authors.lastname: Palmiere
authors.forename: Marc-Pierre
authors.initials: MP
authors.lastname: Augsburger
authors.forename: Patrice
authors.initials: P
authors.lastname: Mangin
authors.forename: Silke
authors.initials: S
authors.lastname: Grabherr
mesh_terms: D000293:Adolescent; D002447:Celiac Plexus / Q000503:physiopathology; D017809:Fatal Outcome; D005554:Forensic Medicine; D006323:Heart Arrest / Q000209:etiology; D006801:Humans; D008297:Male; D016139:Martial Arts; D009102:Multiple Organ Failure / Q000209:etiology; D009200:Myocardial Contraction / Q000502:physiology*; D012018:Reflex / Q000502:physiology*; D013898:Thoracic Injuries / Q000150:complications / Q000503:physiopathology*; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000503:physiopathology*