A Twisted Tale: A Case of Intestinal Volvulus in an 85-Year-Old Female

Area of Science:

• Forensic Pathology
• Gastroenterology
• Internal Medicine

Background:

• Medicolegal death investigation (MDI) often involves sudden, unexpected deaths, with cardiovascular, cerebral, pulmonary, and cancer causes being most common.
• Gastrointestinal conditions are less common causes of death, sometimes presenting with masked or absent pain.
• Intestinal volvulus, a form of intestinal obstruction, can occur at any age and lead to fatal outcomes.

Purpose of the Study:

• To report a case of sudden death attributed to intestinal volvulus in an elderly female.
• To emphasize the importance of considering intestinal volvulus in medicolegal death investigations, especially in cases with vague abdominal symptoms.

Main Methods:

• Autopsy examination of an 85-year-old female who died following vague abdominal complaints and nausea.
• Histopathological examination of the ileum and mesentery.
• Review of the patient's medical history and autopsy findings.

Main Results:

• Autopsy revealed a volvulus of the ileum and adjacent mesentery, with ileal necrosis and 700 cc of bloody peritoneal fluid.
• Major mesenteric arteries were patent, indicating the cause of ischemia was the twisting of the bowel and mesentery.
• The patient, an 85-year-old female with a history of hypothyroidism, was in excellent health prior to death.

Conclusions:

• Intestinal volvulus can cause sudden death, even in seemingly healthy individuals.
• Accurate diagnosis through medicolegal death investigation is crucial for understanding the cause of death and providing answers to families.
• This case underscores the need for thorough investigation of gastrointestinal causes in unexpected deaths.