Forensic considerations in cases of fatal constipation

Area of Science:

• Gastroenterology
• Forensic Pathology

Background:

• Constipation is a prevalent disorder, particularly affecting the elderly and individuals with intellectual disabilities or neuropsychiatric conditions.
• Medications such as analgesics, antidepressants, and antihypertensives are common causes of constipation.
• Symptoms range from mild discomfort to severe complications like fecal impaction and paradoxical diarrhea.

Purpose of the Study:

• To highlight the potentially lethal complications of constipation.
• To emphasize the importance of comprehensive autopsy examination in cases involving constipation and megacolon.
• To underscore the need to consider pre-existing conditions and iatrogenic factors.

Main Methods:

• Review of autopsy findings in cases with constipation and megacolon.
• Analysis of potential causes of death related to constipation.
• Evaluation of medical and drug history, supportive care, and toxicological data.

Main Results:

• Constipation can lead to fatal outcomes through mechanisms including bowel obstruction, stercoral colitis, perforation, peritonitis, respiratory compromise, abdominal compartment syndrome, and venous thromboembolism.
• Treatments for constipation, such as laxatives and enemas, can be lethal.
• Autopsy must consider underlying disorders like Hirschsprung disease and iatrogenic causes.

Conclusions:

• Constipation is a serious condition with potentially fatal complications.
• Thorough autopsy, including review of medical history and toxicology, is crucial for determining the cause of death in constipation-related cases.
• Vulnerable populations and certain medications increase the risk of severe constipation outcomes.