Gilbert John D, Byard Roger W
Forensic Science SA, 21 Divett Place, Adelaide, 5000, Australia.
School of Medicine, Level 3 Medical School North Building, The University of Adelaide, Frome Road, Adelaide, SA, 5005, Australia.
Forensic Sci Med Pathol. 2019 Sep;15(3):491-493. doi: 10.1007/s12024-018-0046-z. Epub 2018 Nov 5.
An 84-year-old woman with a history of weight loss, anorexia and episodic vomiting was admitted to hospital where she died soon afterwards. Her diagnosis was acute renal injury due to dehydration and malnutrition. At autopsy the body was cachectic with a small intestinal obstruction due to herniation through a defect at the anterolateral aspect of the obturator foramen. A poorly differentiated adenocarcinoma of the gastroesophageal junction was also identified with small peripheral pulmonary thromboemboli. Death was due to small bowel obstruction from a left obturator hernia with scattered peripheral pulmonary thromboemboli complicating cachexia due to gastroesophageal adenocarcinoma. Obturator hernias are called the "little old lady's hernia" and occur mainly in elderly, multiparous and malnourished women. The broader female pelvis and wider obturator canal with laxity of ligaments and loss of preperitoneal adipose tissue padding around the canal predispose to herniation. This rare hernia is often first identified at autopsy.
一名84岁女性,有体重减轻、厌食和发作性呕吐病史,入院后不久死亡。她的诊断为脱水和营养不良导致的急性肾损伤。尸检时,尸体消瘦,因闭孔前外侧缺损处的疝形成导致小肠梗阻。还发现了胃食管交界处低分化腺癌及小的外周肺血栓栓塞。死亡原因是左闭孔疝导致的小肠梗阻,以及胃食管腺癌所致恶病质合并散在的外周肺血栓栓塞。闭孔疝被称为“老妇人疝”,主要发生在老年、多产和营养不良的女性中。女性骨盆更宽、闭孔管更宽,加上韧带松弛以及闭孔管周围腹膜前脂肪组织垫缺失,易发生疝形成。这种罕见的疝通常在尸检时首次被发现。