Unusual Causes of Death Due to Constipation

Area of Science:

• Medicine
• Gastroenterology
• Neurology

Background:

• Constipation is common in individuals with intellectual disabilities, autism, and cerebral palsy.
• While often benign, severe constipation can cause life-threatening intestinal obstruction or perforation.
• Rare fatal complications of chronic constipation are not widely recognized.

Purpose of the Study:

• To report two unusual cases of lethal chronic constipation.
• To highlight rare fatal mechanisms associated with severe constipation in vulnerable individuals.
• To inform medicolegal assessments and clinical evaluations.

Main Methods:

• Case report analysis of two deceased adolescent males with developmental disabilities and severe constipation.
• Autopsy findings and clinical history review.
• Pathological examination to determine cause of death.

Main Results:

• Case 1: Death due to pulmonary thromboembolism from pelvic vein compression by acquired megacolon (4.6 kg fecal mass).
• Case 2: Death due to abdominal compartment syndrome during medical evacuation, associated with acquired megacolon/megarectum (6.5 kg fecal mass) and underlying conditions.
• Both cases involved severe chronic constipation leading to acquired megacolon.

Conclusions:

• Severe constipation in individuals with developmental disabilities can result in rare, fatal outcomes.
• Pulmonary thromboembolism and abdominal compartment syndrome should be considered in medicolegal evaluations of sudden death in this population.
• Increased awareness and careful evaluation are crucial for vulnerable individuals with chronic constipation.