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

Medicolegal death investigation (MDI) includes sudden and unexpected deaths, with the most common being cardiovascular deaths, cerebral, pulmonary, and cancer causes. Less commonly, gastrointestinal conditions can occur, and most conditions are symptomatic. Occasionally, pain is masked or absent. Of the many intestinal conditions that may cause death, intestinal volvulus occurs in all ages and is part of the larger intestinal obstruction disease states. The individual in our report was an active, articulate 85-year-old female in excellent health; her medical history was positive only for hypothyroidism, treated for over 30 years with Synthroid. She died following vague abdominal complaints and nausea following a meal. At autopsy, a volvulus of the ileum and adjacent mesentery was present. The ileum was necrotic, and 700 cc of bloody, dark peritoneal fluid was present. Major arteries, including celiac, superior, and inferior mesenteric arteries, were patent. A volvulus occurs when the bowel twists upon its associated mesentery, causing obstruction within the intestine, vascular compromise of the supporting vessels in the mesentery, and ultimate distal ischemia of the affected bowel. Correct assessment in this case provided answers for the family and allowed correct death certificate classification.