Fatal intussusception in infancy: forensic implications

Intussusception is one of the most common causes of intestinal obstructions in younger children, especially infants. Though rare, fatalities due to intussusception are known to be caused by intestinal obstruction associated with peritonitis, generalized sepsis and shock from intestinal infarction due to disruption in blood supply or electrolyte and fluid imbalance. An eight-month-old female infant, who initially presented with a single episode of vomiting and fever (37.8 °C), was examined as an outpatient at the department of pediatrics of a general hospital. Clinical examination revealed no characteristic features of acute abdomen, so the child was sent home. Nine to ten hours later her condition deteriorated: she became hyperpyretic and stuporous. On her way to the University Children's Hospital, the infant died; the death was confirmed upon admission, i.e. some 15 h after the onset of symptoms. The autopsy revealed an 8 cm long intussusception of the distal part of the ileum to the cecum. There was no gross or microscopic evidence of peritonitis at autopsy. The shock caused by intestinal obstruction with consequent intestinal necrosis was considered to be the cause of death.