法医学ジャーナル

Sudden Death- Case series of Ruptured Esophageal Varices

Abstract

Ishita Thakur, Rashid Nehal Khan and Abhijit Rudra

Introduction
Sudden death due to Gastroinstestinal (GI) causes amount to 10% of all sudden death. Esophageal varices is one of the GI causes of sudden death. It develops as a complication of liver cirrhosis. The prevalence of esohgaeal varices in cirrhosis patients is 50% and mortality rate varies between 20%-35% with male female ratio of 1:9. The one year bleeding rate of small and large varices is 5% and 15%. Mortality rate increases with increased age.
Case-Series
Six case of sudden death were seen in the mortuary of a tertiary hospital. The six cases were males, alcoholics. On autopsy, similar findings of cirrhotic liver and hemorrhagic mucosa of the stomach with bleeding spots on lower one third of esophagus were observed.
Discussion
Collaterals develop with development of portal hypertension. Some sites are pre disposed to rupture like the esophageal varices. Risk factors of variceal rupture are red streaks in lumen of esophagus and deranged liver function tests. On gross examination, signs of deranged liver functions are noted. On internal examination, esophagus is everted attached to the stomach and varices are seen shine to through the mucosa. Liver had cirrhotic changes and spleen was enlarged and congested in all the six cases.
Conclusion
The case series emphasizes the importance of fatal esophageal variceal hemorrhage as an important cause of sudden death occurring outside the hospital in alcohol-addicted individuals, often in isolated scenarios.