Unusual gastrointestinal causes of unexpected death in the elderly

Gastrointestinal causes of sudden and unexpected death occur at all ages but are more common at the extremes of life. In the elderly quite significant disease may be present without observable symptoms and signs. Two cases of unexpected deaths due to small intestinal obstruction from unusual occult hernias are reported. Case 1: an 84-year-old woman was found dead lying in bed at her home address. Death was caused by intestinal herniation through a defect created by the greater omentum that had adhered to an area of acute serosal inflammation associated with underlying acute diverticulitis of the jejunum. Case 2: an 83-year-old woman was found dead lying on the kitchen floor at her home address. Death was caused by herniation of a portion of small intestine into a direct inguinal hernial sac that was occupied by an acutely inflamed appendix. These cases demonstrate two uncommon causes of intestinal herniation associated with fatal outcomes. The underlying lethal gastrointestinal disease in both women was only identified at autopsy. As mechanisms of death in such cases may involve quite complex sequences of events, careful stepwise dissection of the intraperitoneal contents may be required to enable the accurate demonstration of underlying anatomical abnormalities that have led to fatal outcomes.