Revisit of gastromalacia: a report of three cases and review of the literature
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CASE REPORT
Revisit of gastromalacia: a report of three cases and review of the literature Hongmei Dong 1,2 & Mingjie Qiu 2 & Qing Gao 2 & Xuebo Li 1 & Liangliang Li 1 Accepted: 29 May 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Gastromalacia, a postmortem dissolution of the stomach, is caused by endogenous enzymes resulting in thinning and softening of the stomach wall with focal perforation. Thus, identifying gastromalacia and differentiating it from other causes of gastric perforation is essential to avoid misdiagnosis. Herein, three cases of gastromalacia are described. The victims died due to hyperthermia, leukemia complicated by cerebral hemorrhage, and asphyxia due to inhaled vomitus, respectively. The macroscopic and microscopic appearance in three cases indicated gastromalacia, although multiple factors confused the diagnosis. Furthermore, the differential diagnosis and the underlying mechanism are discussed. Keywords Postmortem phenomenon . Gastric perforation . Gastromalacia . Autolysis
Introduction Postmortem autolytic rupture of the stomach, also known as gastromalacia, is an uncommon postmortem phenomenon. It was originally reported by John Hunter in the eighteenth century [1] and is known to be caused by the action of endogenous enzymes, leading to softening, thinning, and ultimate perforation of the stomach wall. The lack of vital responses such as peritonitis, hemorrhage, or mucosal inflammation indicates its postmortem nature. Gastromalacia commonly occurs at the gastric fundus, near the gastroesophageal junction [2]. Due to the relaxation of the lower esophageal sphincter after death, reflux of the gastric contents could also cause perforation of the distal esophagus, termed as esophagomalacia. The stomach contents that burst into the abdominal cavity may also cause perforation
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12024-020-00274-9) contains supplementary material, which is available to authorized users. * Hongmei Dong [email protected] 1
Forensic Center, Shandong University of Political Science and Law, 63 Jiefang East Road, Jinan 250014, Shandong, China
2
Department of Forensic Medicine, Tongji Medical College of Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, Hubei 430030, People’s Republic of China
of the diaphragm. This rupture might lead to pneumoperitoneum or pneumothorax being found on postmortem radiographs [3]. Although gastromalacia is a well-recognized postmortem phenomenon, differentiating it from gastric rupture due to other causes might be challenging, which could lead the the forensic pathologist to make misguided conclusions. Herein, we present three cases of gastromalacia and revisit this postmortem phenomenon so as to increase the awareness of the forensic pathologists and hopefully avoid misdiagnosis.
Case report Case 1 A 12-year-old boy in a juvenile correctional center was undergoing strict physical training. His failure to finish the requi
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