Lethal mesenteric perforation by osteophytes after blunt abdominal trauma
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Lethal mesenteric perforation by osteophytes after blunt abdominal trauma Arnaud Le Gallo 1 & Christophe Loire 1 & Maisy Lossois 2 & Pierre-Antoine Peyron 2 Accepted: 17 February 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract A 50 year-old homeless man was found dead the day after he had sustained blunt abdominal trauma during a physical assault. Autopsy revealed no apparent injury to the abdominal wall, but showed a massive hemoperitoneum resulting from a large (8 cm) tear of the mesenteric root. It also revealed prominent and diffuse spinal osteophytes predominating in the lumbar region, where they were fused and formed a large anterior ossified excrescence. The diagnosis of diffuse idiopathic skeletal hyperostosis was established in the presence of continuous ossification along the anterior aspect of five contiguous vertebral bodies, without any additional features of degenerative disease on imaging. Death was attributed to intra-abdominal hemorrhage due to mesenteric perforation caused by blunt abdominal trauma in the context of diffuse idiopathic skeletal hyperostosis. This pre-existing condition was considered an aggravating factor, as anterior lumbar osteophytosis had made the mesentery more vulnerable to blunt trauma by reducing both the space separating the abdominal wall from the spine and the surface of interaction between the spine and the mesentery. Only a few cases of osteophyte-related visceral injury have been described in the literature. To our knowledge, this is the first reported case of lethal abdominal injury caused by osteophytes after blunt trauma. Keywords Blunt abdominal trauma . Mesentery . Laceration . Hemoperitoneum . Diffuse idiopathic skeletal hyperostosis . Autopsy
Case report A 50-year-old homeless man with no known medical history other than chronic alcoholism was found dead, lying on his back on a mattress, at the home of a friend who was temporarily housing him. The day before, the man had returned home in an acute state of alcohol intoxication, claiming to have been hit by a third party, and complaining of severe abdominal pain, which forced him to remain in bed. His death was finally recorded 24 h after the assault, and a medicolegal autopsy was ordered. Post-mortem computed tomography (CT) scan revealed a large hemoperitoneum with no free pneumoperitoneum. It
* Pierre-Antoine Peyron [email protected] 1
Institut de Médecine Légale, CHU de La Réunion, Allée des Topazes, 97400 Saint-Denis, France
2
Département de Médecine Légale, CHU de Montpellier, 371 avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France
also showed multiple fused anterior osteophytes of the spine. The most prominent osteophytes were located on the 2nd, 3rd and 4th lumbar vertebrae, where they formed a large left anterolateral overhang of more than 2 cm (Figs. 1, 2, and 3). The diagnosis of diffuse idiopathic skeletal hyperostosis was established in the presence of two thoracic vertebral segments with continuous ossification of
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