Postmortem gastric perforation (gastromalacia) mimicking abusive injury in sudden unexplained infant death.

Gastromalacia is a postmortem autolysis of gastric tissue that can culminate in gastric perforation. This entity is well-recognized by pathologists but is rarely encountered by diagnostic radiologists. We are reporting a case of sudden unexplained infant death (SUID) in which a boy was found to have pneumoperitoneum on postmortem radiographs, subsequently proved by autopsy to be caused by postmortem gastric perforation resulting from gastromalacia. It is important for radiologists to recognize this entity so as not to mistake it for bowel perforation caused by antemortem pathology, including inflicted trauma.