Byard, Roger; Tiemensma, Marianne

Author(s)

Byard, Roger

Tiemensma, Marianne

Publication Date

2024-12-23

Abstract

Constipation is found in individuals with intellectual disabilities, autism, and cerebral palsy. Although generally a benign condition, it may lead to life-threatening intestinal obstruction, with or without volvulus, or to stercoral ulceration with enteritis and/or perforation. Two unusual cases of lethal chronic constipation are reported to demonstrate other very rare fatal mechanisms that may occur. Case 1: A 17-year-old male with cerebral palsy and autism was found deceased in bed. Death was due to pulmonary thromboembolism arising from compression of pelvic veins by acquired megacolon due to constipation (fecal mass 4.6 kg). Case 2: A second 17-year-old male with intellectual disability, global developmental delay, attention deficit disorder, seizures, and hypotonia collapsed and died during a medical evacuation from a remote community. Death was due to abdominal compartment syndrome in the context of medical air transport (medical retrieval), chronic constipation with acquired megacolon and megarectum (fecal mass 6.5 kg), global developmental delay, intellectual disability, and a suspected underlying genetic syndrome. These cases demonstrate that individuals with constipation may present for medicolegal assessment following sudden collapse/death and that pulmonary thromboembolism and abdominal compartment syndrome should be considered as rare possibilities in the evaluation of vulnerable individuals.

Affiliation

From Forensic Science SA and the Adelaide School of Biomedicine, The University of Adelaide, Adelaide, South Australia.

Forensic Pathology Unit, Royal Darwin Hospital, Darwin, Northern Territory and College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.

Citation

Am J Forensic Med Pathol . 2024 Dec 23. doi: 10.1097/PAF.0000000000001005. Online ahead of print.

ISSN

1533-404X

Pubmed ID

https://pubmed.ncbi.nlm.nih.gov/39746067/?otool=iaurydwlib

Link

https://hdl.handle.net/10137/13903

Title

Unusual Causes of Death Due to Constipation.

Type of document

Journal Article

Entity Type

Publication

Author(s)	Byard, Roger Tiemensma, Marianne
Publication Date	2024-12-23
Abstract	Constipation is found in individuals with intellectual disabilities, autism, and cerebral palsy. Although generally a benign condition, it may lead to life-threatening intestinal obstruction, with or without volvulus, or to stercoral ulceration with enteritis and/or perforation. Two unusual cases of lethal chronic constipation are reported to demonstrate other very rare fatal mechanisms that may occur. Case 1: A 17-year-old male with cerebral palsy and autism was found deceased in bed. Death was due to pulmonary thromboembolism arising from compression of pelvic veins by acquired megacolon due to constipation (fecal mass 4.6 kg). Case 2: A second 17-year-old male with intellectual disability, global developmental delay, attention deficit disorder, seizures, and hypotonia collapsed and died during a medical evacuation from a remote community. Death was due to abdominal compartment syndrome in the context of medical air transport (medical retrieval), chronic constipation with acquired megacolon and megarectum (fecal mass 6.5 kg), global developmental delay, intellectual disability, and a suspected underlying genetic syndrome. These cases demonstrate that individuals with constipation may present for medicolegal assessment following sudden collapse/death and that pulmonary thromboembolism and abdominal compartment syndrome should be considered as rare possibilities in the evaluation of vulnerable individuals.
Affiliation	From Forensic Science SA and the Adelaide School of Biomedicine, The University of Adelaide, Adelaide, South Australia. Forensic Pathology Unit, Royal Darwin Hospital, Darwin, Northern Territory and College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
Citation	Am J Forensic Med Pathol . 2024 Dec 23. doi: 10.1097/PAF.0000000000001005. Online ahead of print.
ISSN	1533-404X
Pubmed ID	https://pubmed.ncbi.nlm.nih.gov/39746067/?otool=iaurydwlib
Link	https://hdl.handle.net/10137/13903
Title	Unusual Causes of Death Due to Constipation.
Type of document	Journal Article
Entity Type	Publication

Unusual Causes of Death Due to Constipation.

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