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Use of contrast-enhanced post-mortem computed tomography to diagnose intestinal perforation caused by malpractice: A
Zhuoqun Wang1, Kaijun Ma2, Lei Wan1
1Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai.
Rationale:
The application of post-mortem computed tomography (PMCT) and PMCT angiography (PMCTA) is becoming increasingly common in forensic investigations. One of the most frequently applied techniques today is PMCTA. However, few studies have focused on the application of contrast-enhanced PMCT of hollow organs such as the gastrointestinal tract. The intestine is a special digestive organ with a complicated anatomical structure; it is difficult to separate in medicolegal investigations, during which new rupture may occur, affecting the examiner's judgment. Moreover, the formalin-fixed intestine is more difficult to separate because of its increased brittleness. In the present case, the authors applied contrast-enhanced PMCT to the diagnosis of intestinal perforation caused by a medical accident.
Patient Concerns:
A 67-year-old woman with cholecystitis underwent laparoscopic cholecystectomy in the hospital. The gallbladder was successfully removed, but the doctor was suspected to have accidentally perforated her intestinal tract with the laparoscopic machinery. The patient developed severe peritonitis and died after the operation.
Diagnosis, Interventions, And Outcomes:
Contrast-enhanced PMCT with isolation of the intestinal tract was performed after dissection of the body. The results suggested that the contrast agent flowed out through the rupture. The autopsy and histological examination revealed a perforated crevasse, confirming the cause of peritonitis while excluding other probabilities despite the doctor's denial.
Lessons:
Contrast-enhanced PMCT was an effective technique with which to interpret this gastrointestinal tract rupture and served as a non-invasive tool for identifying the injury.
Insights
Post-mortem CT angiography (PMCTA) effectively diagnosed a fatal gastrointestinal tract rupture from a medical accident. This non-invasive technique identified intestinal perforation, aiding forensic investigations.
Area of Science:
- Forensic Radiology
- Medical Imaging
- Gastroenterology
Background:
- Post-mortem computed tomography (PMCT) and PMCT angiography (PMCTA) are increasingly used in forensic science.
- Few studies have explored contrast-enhanced PMCT for hollow organs like the gastrointestinal tract.
- Intestinal anatomy presents challenges in medicolegal investigations, risking artifactual injury.
Observation:
- A 67-year-old woman died from peritonitis after laparoscopic cholecystectomy, with suspected accidental intestinal perforation.
- Contrast-enhanced PMCT with intestinal isolation was performed post-mortem.
- Autopsy and histology confirmed a perforated intestinal rupture.
Findings:
- Contrast-enhanced PMCT revealed contrast leakage through a gastrointestinal tract rupture.
- The technique successfully identified the site and cause of intestinal perforation.
- Findings confirmed peritonitis resulted from the iatrogenic injury.
Implications:
- Contrast-enhanced PMCT is a valuable non-invasive tool for diagnosing gastrointestinal tract injuries in forensic cases.
- This method aids in determining the cause of death and clarifying medical accident circumstances.
- PMCT can overcome challenges associated with examining fragile, formalin-fixed tissues.
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