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An infant autopsy case of bowel obstruction due to internal abdominal hernia
Hiromitsu Kurata1, Akiko Ishigami2, Itsuo Tokunaga2
1Department of Forensic Medicine, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan; Department of Physical Medicine, Nakazu-Yagi Hospital, Tokushima, Japan.
Insights
Internal abdominal hernia, a rare cause of infant death, can lead to fatal bowel obstruction. Autopsy revealed asphyxiation from milk aspiration as the cause of death in a 3-month-old.
Area of Science:
- Pediatric Pathology
- Gastroenterology
- Forensic Medicine
Background:
- Internal abdominal hernia, protrusion of viscera through mesenteric defects, is a rare condition with varied presentations.
- Sudden infant death from internal abdominal hernia is exceptionally rare, with only four prior autopsy reports.
Observation:
- A 3-month-old infant experienced sudden death following vomiting.
- Autopsy revealed extensive bowel obstruction with necrosis secondary to a congenital mesenteric defect.
- Gastric content was found aspirated into the larynx and lungs.
Findings:
- The cause of death was determined to be asphyxiation due to aspiration of viscous milk/vomitus.
- The aspiration was a consequence of bowel obstruction caused by an internal abdominal hernia.
Implications:
- Autopsy is critical for diagnosing the cause of sudden unexpected infant death.
- Analysis of gastric and airway contents during autopsy aids in confirming aspiration events.
Abstract:
Internal abdominal hernia, defined as protrusion of viscera through a defect of the mesentery, has been considered a rare clinical entity. Recent clinical reviews reported a wide range of onset age (from newborns to the elderly) and symptoms (from minimal abdominal symptoms to severe acute abdomen). Sudden and unexpected death due to internal abdominal hernia is rare in infants or toddlers, and only 4 autopsy cases had been reported previously. We report the case of a 3-month-old Japanese boy who unexpectedly died 4 h after first vomiting. Autopsy showed a wide bowel obstruction with necrosis through a congenital mesenteric defect. The larynx was filled with gastric content (milky white viscous muddy material). In the cross section of both lungs, the same material was found to be expressed from the bronchioles. We diagnosed the cause of death as asphyxiation by viscous milk/vomitus aspiration caused by bowel obstruction due to an internal abdominal hernia. In case of sudden and unexpected death of an infant, autopsy is crucial to determine the cause of death. During autopsy, it is helpful to determine the character and distribution of gastric and airway contents to confirm milk or vomitus aspiration.
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