Hitosugi M, Kitamura O, Takatsu A
Department of Forensic Medicine, Jikei University, School of Medicine, Tokyo, Japan.
Nihon Hoigaku Zasshi. 1998 Jun;52(3):211-4.
We describe a case of sudden death caused by a rare complication of Crohn's disease. A 29-year-old man with Crohn's disease who had not taken medications regularly complained of nausea, vomiting, and abdominal pain for 2 days, and then died suddenly. Autopsy revealed protruding intestinal loops filled with gas, internal fistulas between fused loops of the terminal ileum, and complete obstruction of the fistulous tract. The histologic findings of transmural inflammation consisting of lymphocytic infiltration, accumulation of partially hyalinized collagen, and fibrosis in the skip areas from the ileum to the cecum were compatible with Crohn's disease. Furthermore, marked emaciation, atrophic change of the heart muscle, and diffuse fatty change of the liver were found. Although the patient died of obstructive ileus caused by a stricture produced by progression of Crohn's disease, he was severely affected by malnutrition which may have been fatal. This case not only illustrates that Crohn's disease can cause obstructive ileus and sudden death, but also makes the forensic pathologist realize the importance of suspecting the presence of an active inflammatory bowel disease in a patient with internal fistulas or malnutrition.
我们描述了一例因克罗恩病罕见并发症导致的猝死病例。一名29岁的克罗恩病男性患者，未规律服药，主诉恶心、呕吐和腹痛2天，随后突然死亡。尸检发现肠袢突出，充满气体，回肠末端融合肠袢之间存在内瘘，瘘管完全阻塞。从回肠至盲肠的跳跃区域出现由淋巴细胞浸润、部分透明化胶原积聚和纤维化组成的透壁性炎症，组织学表现符合克罗恩病。此外，还发现明显消瘦、心肌萎缩性改变和肝脏弥漫性脂肪变性。尽管患者死于克罗恩病进展导致的狭窄引起的肠梗阻，但他受到严重营养不良的影响，这可能是致命的。该病例不仅说明克罗恩病可导致肠梗阻和猝死，也使法医病理学家认识到在患有内瘘或营养不良的患者中怀疑存在活动性炎症性肠病的重要性。
