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Lethal mesenteric perforation by osteophytes after blunt abdominal trauma

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Abstract

A 50 year-old homeless man was found dead the day after he had sustained blunt abdominal trauma during a physical assault. Autopsy revealed no apparent injury to the abdominal wall, but showed a massive hemoperitoneum resulting from a large (8 cm) tear of the mesenteric root. It also revealed prominent and diffuse spinal osteophytes predominating in the lumbar region, where they were fused and formed a large anterior ossified excrescence. The diagnosis of diffuse idiopathic skeletal hyperostosis was established in the presence of continuous ossification along the anterior aspect of five contiguous vertebral bodies, without any additional features of degenerative disease on imaging. Death was attributed to intra-abdominal hemorrhage due to mesenteric perforation caused by blunt abdominal trauma in the context of diffuse idiopathic skeletal hyperostosis. This pre-existing condition was considered an aggravating factor, as anterior lumbar osteophytosis had made the mesentery more vulnerable to blunt trauma by reducing both the space separating the abdominal wall from the spine and the surface of interaction between the spine and the mesentery. Only a few cases of osteophyte-related visceral injury have been described in the literature. To our knowledge, this is the first reported case of lethal abdominal injury caused by osteophytes after blunt trauma.

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Acknowledgements

The authors thank Mrs. Arianne Dorval and Mr. John Kelleher for reviewing the manuscript.

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Authors and Affiliations

  1. Institut de Médecine Légale, CHU de La Réunion, Allée des Topazes, 97400, Saint-Denis, France

    Arnaud Le Gallo & Christophe Loire

  2. Département de Médecine Légale, CHU de Montpellier, 371 avenue du Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France

    Maisy Lossois & Pierre-Antoine Peyron

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  1. Arnaud Le Gallo
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  2. Christophe Loire
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  3. Maisy Lossois
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  4. Pierre-Antoine Peyron
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Correspondence to Pierre-Antoine Peyron.

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Le Gallo, A., Loire, C., Lossois, M. et al. Lethal mesenteric perforation by osteophytes after blunt abdominal trauma. Forensic Sci Med Pathol 16, 535–539 (2020). https://doi.org/10.1007/s12024-020-00238-z

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