11.-SUDDEN DEATH IN ADOLESCENT.PROF.GARFIA.A

11.-SUDDEN AND UNEXPECTED DEATH IN AN ADOLESCENT:INTESTINAL DUPLICATION. Prof.GARFIA.A

CASE REPORT

     It is presented a case of sudden unexpected death, in a 19 year-old adolescent, who in the hours prior to his death presented a clinical picture of dizziness, nausea and vomiting which was treated at the First-Aid Centre with analgesics and antispasmodics. After a few hours the patient was again taken to the Medical Centre by his relatives, by then unconscious. In spite of resuscitation measures the patient presented cardio-respiratory arrest and sudden death. During the autopsy the existence of a mesenteric tumor was discovered in the distal ileum. The corpse gave off a peculiar smell which reminded the Prosector of the typical smell of some organophosphorous pesticides. The following diagnoses for the cause of death were put forward in the autopsy report:

1.- Septic shock due to intestinal abscess. 
2.-Mortal poisoning by pesticides. 
3.-Sudden death of cardiac origin. 

   The chemical investigation resulted negative. The histopathologic study did not show cardiac lesions which could justify the death. The investigation of the intestinal tumor showed that it was a cystic intestinal duplication, with a slight chronic inflamation of the intestinal wall duplication. Perforations, haemorrhage, ischaemic or vascular intestinal lesions which could have justified sudden unexpected death -with digestive causes- were not seen.

The Cause and Manner of Death were considered undetermined.

PROF. GARFIA.A
BLOG 11
FORENSICPATHOLOGYFORUM

FIG. 1.- To show the macroscopical aspect of the cystic intestinal duplication. The cystic wall was similar to the intestinal wall and we found -inside the cyst- a sebaous-gelatinous material brownish. 
Prof.Garfia.A

PROF. GARFIA.A
BLOG 11
FORENSICPATHOLOGYFORUM

FIG.2 .-To show the intestinal normal wall (above) and the cystic intestinal duplication wall (down).Prof. Garfia.A

LI.- Intestinal normal lumen.

LDU.- Lumen of the cystic duplication.

M.- Mucosae.

S.-Submucosae.

MI.-Internal Muscularis.

ME.- External Muscularis which is shared between the normal intestinal wall and the cystic wall duplication.

PROF. GARFIA.A
BLOG 11
FORENSICPATHOLOGYFORUM

FIG.3.- The cystic mucosae( m) appeared constituted by several layers of macrophagical cells (arrows) and cellular necrotic debris on the luminal surface. Prof.Garfia.A

PROF. GARFIA.A
BLOG 11
FORENSICPATHOLOGYFORUM

FIG. 4.- Shows the external cystic wall. Mi= internal muscularis.ME=external muscularis. SP= peritoneal serous. Note the slight linfocitary infiltration in the muscularis wall and focally in the peritoneal serous. Prof.Garfia.A