Postmortem CT findings of gastromalacia: a trap for the radiologist with forensic interest

Autolytic rupture of the stomach, so called gastromalacia, is a well recognized artifact at autopsy. A 50 year old Asian woman with a past history of alcoholism, head injury and posttraumatic epilepsy was found deceased at home following a 12 h period of feeling unwell, seizures and vomiting. Postmortem CT images of the abdomen showed free gas in the peritoneal cavity adjacent to the stomach and no other abnormality. There were no external or radiological features of putrefaction. Appearances were stated by a radiologist to be strongly suggestive of gastro-intestinal tract perforation. Autopsy revealed typical findings of autolytic gastric rupture without features of peritonitis. Cause of death was determined by the pathologist to be "complication of status epilepticus (posttraumatic)". This case demonstrates that gastromalacia may occur rapidly after death and can be detected on postmortem CT, even in the absence of external putrefactive features or CT findings of putrefaction such as gas within the anterior abdominal wall, cardiac chambers or hepatic vasculature. The radiologist with forensic interest must be aware of this postmortem CT artifact in order to avoid ascribing the presence of free intra-peritoneal gas to antemortem perforation of the bowel.