Sudden and Unexpected Death from Natural Causes

Sudden and Unexpected Sudden and Unexpected Death from Natural CausesDeath from Natural CausesSudden and Unexpected Sudden and Unexpected Death from Natural CausesDeath from Natural Causes

Section 1 General consideration 1. Definition of sudden unexpected death

The definition of sudden unexpected death is The definition of sudden unexpected death is referred to as a sudden death of an individual who referred to as a sudden death of an individual who appears healthy and dies suddenly within a few minutes appears healthy and dies suddenly within a few minutes or several hours due to pre-existing disease or functional or several hours due to pre-existing disease or functional disorder. disorder.

The official definition of a sudden unexpected death The official definition of a sudden unexpected death as described by WHO is that an individual dies from as described by WHO is that an individual dies from natural diseases within 24 hours since symptoms appear.natural diseases within 24 hours since symptoms appear.

Section 1 General consideration 1. Definition of sudden unexpected death

The definition of sudden unexpected death is The definition of sudden unexpected death is referred to as a sudden death of an individual who referred to as a sudden death of an individual who appears healthy and dies suddenly within a few minutes appears healthy and dies suddenly within a few minutes or several hours due to pre-existing disease or functional or several hours due to pre-existing disease or functional disorder. disorder.

The official definition of a sudden unexpected death The official definition of a sudden unexpected death as described by WHO is that an individual dies from as described by WHO is that an individual dies from natural diseases within 24 hours since symptoms appear.natural diseases within 24 hours since symptoms appear.

Three characteristics in the cases of sudden and Three characteristics in the cases of sudden and

unexpected death:unexpected death:

(a) The suddenness of the death;(a) The suddenness of the death;

(b) The unexpectedness of the death;(b) The unexpectedness of the death;

(c) Natural diseases or functional disorders as the causes (c) Natural diseases or functional disorders as the causes of death.of death.

The violent deaths, although occurring suddenly in The violent deaths, although occurring suddenly in most cases as they do, are not within the scope of sudden most cases as they do, are not within the scope of sudden unexpected death.unexpected death.

2. Causes of sudden unexpected death

Diseases of any human physical system may lead to Diseases of any human physical system may lead to

sudden unexpected death.sudden unexpected death.

Leading causes: diseases of cardiovascular system, the Leading causes: diseases of cardiovascular system, the

diseases of central nervous system and respiratory system diseases of central nervous system and respiratory system

rank second. The diseases of gastrointestinal and rank second. The diseases of gastrointestinal and

genitourinary system are less commonly to cause the genitourinary system are less commonly to cause the


2. Causes of sudden unexpected death

Diseases of any human physical system may lead to Diseases of any human physical system may lead to


Leading causes: diseases of cardiovascular system, the Leading causes: diseases of cardiovascular system, the

diseases of central nervous system and respiratory system diseases of central nervous system and respiratory system

rank second. The diseases of gastrointestinal and rank second. The diseases of gastrointestinal and

genitourinary system are less commonly to cause the genitourinary system are less commonly to cause the


Diseases of respiratory system are most commonly Diseases of respiratory system are most commonly

seen to lead to sudden death in neonate and children. seen to lead to sudden death in neonate and children.

Diseases of cardiovascular system account for the Diseases of cardiovascular system account for the

major cause in the sudden unexpected deaths in adults.major cause in the sudden unexpected deaths in adults.

Certain external factors such as emotional distress Certain external factors such as emotional distress

and physical exertion may predispose the onset of the and physical exertion may predispose the onset of the

disease that leads to the sudden death. disease that leads to the sudden death.

Diseases of respiratory system are most commonly Diseases of respiratory system are most commonly

seen to lead to sudden death in neonate and children. seen to lead to sudden death in neonate and children.

Diseases of cardiovascular system account for the Diseases of cardiovascular system account for the

major cause in the sudden unexpected deaths in adults.major cause in the sudden unexpected deaths in adults.

Certain external factors such as emotional distress Certain external factors such as emotional distress

and physical exertion may predispose the onset of the and physical exertion may predispose the onset of the

disease that leads to the sudden death. disease that leads to the sudden death.

3. The purposes for medico-legal investigation in sudden unexpected death Medico-legal autopsy must be conducted under the Medico-legal autopsy must be conducted under the following conditions:following conditions:

1.1. In cases suspected to be violent death. In cases suspected to be violent death.

2.2. In cases of violent deaths that have been disguised to In cases of violent deaths that have been disguised to be sudden unexpected death from natural causes.be sudden unexpected death from natural causes.

By medico-legal investigation, some occupational or By medico-legal investigation, some occupational or grave infectious diseases may be detected. Proper grave infectious diseases may be detected. Proper prophylactic measurements may be taken.prophylactic measurements may be taken.

3. The purposes for medico-legal investigation in sudden unexpected death Medico-legal autopsy must be conducted under the Medico-legal autopsy must be conducted under the following conditions:following conditions:

1.1. In cases suspected to be violent death. In cases suspected to be violent death.

2.2. In cases of violent deaths that have been disguised to In cases of violent deaths that have been disguised to be sudden unexpected death from natural causes.be sudden unexpected death from natural causes.

By medico-legal investigation, some occupational or By medico-legal investigation, some occupational or grave infectious diseases may be detected. Proper grave infectious diseases may be detected. Proper prophylactic measurements may be taken.prophylactic measurements may be taken.

Section 2 The common causes of sudden Section 2 The common causes of sudden and unexpected deathand unexpected death

1. Cardiovascular system1. Cardiovascular system Most sudden and unexpected deaths are caused by Most sudden and unexpected deaths are caused by lesions in the cardiovascular system.lesions in the cardiovascular system. (1) Coronary artery disease(1) Coronary artery disease i. Coronary insufficiencyi. Coronary insufficiency Coronary insufficiency from narrowing of the lumen Coronary insufficiency from narrowing of the lumen of major vessels may lead to chronic ischemia and of major vessels may lead to chronic ischemia and hypoxia of the muscle distal to the stenosis.hypoxia of the muscle distal to the stenosis. If the ischemia region involves the pace-maker node If the ischemia region involves the pace-maker node or a major branch of the conducting system, the liability or a major branch of the conducting system, the liability to rhythm abnormalities is increased.to rhythm abnormalities is increased.

Section 2 The common causes of sudden Section 2 The common causes of sudden and unexpected deathand unexpected death

1. Cardiovascular system1. Cardiovascular system Most sudden and unexpected deaths are caused by Most sudden and unexpected deaths are caused by lesions in the cardiovascular system.lesions in the cardiovascular system. (1) Coronary artery disease(1) Coronary artery disease i. Coronary insufficiencyi. Coronary insufficiency Coronary insufficiency from narrowing of the lumen Coronary insufficiency from narrowing of the lumen of major vessels may lead to chronic ischemia and of major vessels may lead to chronic ischemia and hypoxia of the muscle distal to the stenosis.hypoxia of the muscle distal to the stenosis. If the ischemia region involves the pace-maker node If the ischemia region involves the pace-maker node or a major branch of the conducting system, the liability or a major branch of the conducting system, the liability to rhythm abnormalities is increased.to rhythm abnormalities is increased.

ii. Complications of atheromaii. Complications of atheroma

Ulcerative atheromatous plaques may rupture, filling tUlcerative atheromatous plaques may rupture, filling t

he vessel partially or completely with cholesterol, fat and fihe vessel partially or completely with cholesterol, fat and fi

brous debris. brous debris.

The endothelial cap of a ruptured plague may act as a The endothelial cap of a ruptured plague may act as a

valve within the vessel and cause a complete obstruction.valve within the vessel and cause a complete obstruction.

Sub-intimal hemorrhage, where bleeding occurs into a plagSub-intimal hemorrhage, where bleeding occurs into a plag

ue, expanding it suddenly and often reducing or blocking tue, expanding it suddenly and often reducing or blocking t

he lumen.he lumen.

ii. Complications of atheromaii. Complications of atheroma

Ulcerative atheromatous plaques may rupture, filling tUlcerative atheromatous plaques may rupture, filling t

he vessel partially or completely with cholesterol, fat and fihe vessel partially or completely with cholesterol, fat and fi

brous debris. brous debris.

The endothelial cap of a ruptured plague may act as a The endothelial cap of a ruptured plague may act as a

valve within the vessel and cause a complete obstruction.valve within the vessel and cause a complete obstruction.

Sub-intimal hemorrhage, where bleeding occurs into a plagSub-intimal hemorrhage, where bleeding occurs into a plag

ue, expanding it suddenly and often reducing or blocking tue, expanding it suddenly and often reducing or blocking t

he lumen.he lumen.

Coronary atheromaCoronary atheromaCoronary atheromaCoronary atheroma

Coronary atheromaCoronary atheromaCoronary atheromaCoronary atheroma

iii. Coronary thrombosisiii. Coronary thrombosis

Less than one-third of sudden cardiac deaths has beeLess than one-third of sudden cardiac deaths has bee

n detected to have a coronary thrombus at autopsy as purn detected to have a coronary thrombus at autopsy as pur

e stenosis and complications of atheroma are much more ce stenosis and complications of atheroma are much more c

ommon.ommon.

Thrombi are still frequent and are often associated wThrombi are still frequent and are often associated w

ith a myocardial infarct. ith a myocardial infarct.

Multiple thrombi also occur, some being post-infarctiMultiple thrombi also occur, some being post-infarcti

on, due to a stagnant circulation.on, due to a stagnant circulation.

iii. Coronary thrombosisiii. Coronary thrombosis

Less than one-third of sudden cardiac deaths has beeLess than one-third of sudden cardiac deaths has bee

n detected to have a coronary thrombus at autopsy as purn detected to have a coronary thrombus at autopsy as pur

e stenosis and complications of atheroma are much more ce stenosis and complications of atheroma are much more c

ommon.ommon.

Thrombi are still frequent and are often associated wThrombi are still frequent and are often associated w

ith a myocardial infarct. ith a myocardial infarct.

Multiple thrombi also occur, some being post-infarctiMultiple thrombi also occur, some being post-infarcti

on, due to a stagnant circulation.on, due to a stagnant circulation.

iv. Myocardial infarctioniv. Myocardial infarction Myocardial infarction occurs when a severe or a Myocardial infarction occurs when a severe or a complete occlusion occurs in a coronary artery, and if the complete occlusion occurs in a coronary artery, and if the collateral circulation is not sufficient to maintain the collateral circulation is not sufficient to maintain the muscle. muscle. If 70% or more of the lumen of a major branch is If 70% or more of the lumen of a major branch is blocked, an infarct commonly develops.blocked, an infarct commonly develops. The effect of a large infarct is either to reduce cardiac The effect of a large infarct is either to reduce cardiac function because of pump failure, as the necrotized muscle function because of pump failure, as the necrotized muscle cannot contract, or it leads to arrhythmias and ventricular cannot contract, or it leads to arrhythmias and ventricular fibrillation.fibrillation. The fatal effects of an infarct may appear at any time The fatal effects of an infarct may appear at any time after the muscle has become ischemic though many hours after the muscle has become ischemic though many hours are needed for an infarct to become visible.are needed for an infarct to become visible.

iv. Myocardial infarctioniv. Myocardial infarction Myocardial infarction occurs when a severe or a Myocardial infarction occurs when a severe or a complete occlusion occurs in a coronary artery, and if the complete occlusion occurs in a coronary artery, and if the collateral circulation is not sufficient to maintain the collateral circulation is not sufficient to maintain the muscle. muscle. If 70% or more of the lumen of a major branch is If 70% or more of the lumen of a major branch is blocked, an infarct commonly develops.blocked, an infarct commonly develops. The effect of a large infarct is either to reduce cardiac The effect of a large infarct is either to reduce cardiac function because of pump failure, as the necrotized muscle function because of pump failure, as the necrotized muscle cannot contract, or it leads to arrhythmias and ventricular cannot contract, or it leads to arrhythmias and ventricular fibrillation.fibrillation. The fatal effects of an infarct may appear at any time The fatal effects of an infarct may appear at any time after the muscle has become ischemic though many hours after the muscle has become ischemic though many hours are needed for an infarct to become visible.are needed for an infarct to become visible.

Figure 17.1 The paler area at the lower edge is a regional myocardial infarction of several days' duration.

Figure 17.2 Haemopericardium due to a ruptured anterior myocardial infarct. Death was due to cardiac tamponade.

Myocardial infarctionMyocardial infarctionMyocardial infarctionMyocardial infarction



v. Rupture of myocardial infarctv. Rupture of myocardial infarct

A ruptured myocardial infarct may cause sudden deaA ruptured myocardial infarct may cause sudden death from a hemopericardium and cardiac tamponade. th from a hemopericardium and cardiac tamponade.

Most commonly found in old person, who have a soft, Most commonly found in old person, who have a soft, senile myocardium, but can occur in anyone. senile myocardium, but can occur in anyone.

Tends to take place two or three days after the onset oTends to take place two or three days after the onset of the infarction when the necrotic muscle is becoming soft. f the infarction when the necrotic muscle is becoming soft.

Mural thrombus may develop over the inner surface Mural thrombus may develop over the inner surface of a myocardial infarct. Parts of it may break off, leading of a myocardial infarct. Parts of it may break off, leading to emboli in the systemic circulation, which may cause infto emboli in the systemic circulation, which may cause infarcts in kidney, spleen and brain.arcts in kidney, spleen and brain.

v. Rupture of myocardial infarctv. Rupture of myocardial infarct

A ruptured myocardial infarct may cause sudden deaA ruptured myocardial infarct may cause sudden death from a hemopericardium and cardiac tamponade. th from a hemopericardium and cardiac tamponade.

Most commonly found in old person, who have a soft, Most commonly found in old person, who have a soft, senile myocardium, but can occur in anyone. senile myocardium, but can occur in anyone.

Tends to take place two or three days after the onset oTends to take place two or three days after the onset of the infarction when the necrotic muscle is becoming soft. f the infarction when the necrotic muscle is becoming soft.

Mural thrombus may develop over the inner surface Mural thrombus may develop over the inner surface of a myocardial infarct. Parts of it may break off, leading of a myocardial infarct. Parts of it may break off, leading to emboli in the systemic circulation, which may cause infto emboli in the systemic circulation, which may cause infarcts in kidney, spleen and brain.arcts in kidney, spleen and brain.

Rupture of myocardial infarctRupture of myocardial infarctRupture of myocardial infarctRupture of myocardial infarct

vi. Myocardial fibrosisvi. Myocardial fibrosis

Another complication of myocardial infarction is the Another complication of myocardial infarction is the myocardial fibrosis which may develop when a myocardial myocardial fibrosis which may develop when a myocardial infarct heals. infarct heals.

Large plaques on the endocardium, or in the wall of tLarge plaques on the endocardium, or in the wall of the ventricle or septum may later interfere with cardiac funhe ventricle or septum may later interfere with cardiac function or with the conducting system. ction or with the conducting system.

A large fibrotic area on the free wall of the left ventricA large fibrotic area on the free wall of the left ventricle may later swell due to the high pressure during systole, fle may later swell due to the high pressure during systole, forming a cardiac aneurysm. These aneurysms rarely ruptuorming a cardiac aneurysm. These aneurysms rarely rupture, as they are tough and fibrotic.re, as they are tough and fibrotic.

vi. Myocardial fibrosisvi. Myocardial fibrosis

Another complication of myocardial infarction is the Another complication of myocardial infarction is the myocardial fibrosis which may develop when a myocardial myocardial fibrosis which may develop when a myocardial infarct heals. infarct heals.

Large plaques on the endocardium, or in the wall of tLarge plaques on the endocardium, or in the wall of the ventricle or septum may later interfere with cardiac funhe ventricle or septum may later interfere with cardiac function or with the conducting system. ction or with the conducting system.

A large fibrotic area on the free wall of the left ventricA large fibrotic area on the free wall of the left ventricle may later swell due to the high pressure during systole, fle may later swell due to the high pressure during systole, forming a cardiac aneurysm. These aneurysms rarely ruptuorming a cardiac aneurysm. These aneurysms rarely rupture, as they are tough and fibrotic.re, as they are tough and fibrotic.

vii. Papillary muscle rupturevii. Papillary muscle rupture

This can occur due to infarction and necrosis, and alThis can occur due to infarction and necrosis, and al

low part of the mitral valve to prolapse, with signs of valvlow part of the mitral valve to prolapse, with signs of valv

e insufficiency and perhaps sudden death.e insufficiency and perhaps sudden death.

vii. Papillary muscle rupturevii. Papillary muscle rupture

This can occur due to infarction and necrosis, and alThis can occur due to infarction and necrosis, and al

low part of the mitral valve to prolapse, with signs of valvlow part of the mitral valve to prolapse, with signs of valv

e insufficiency and perhaps sudden death.e insufficiency and perhaps sudden death.

(2) Hypertensive heart disease(2) Hypertensive heart disease

This condition may lead to sudden cardiac death from leThis condition may lead to sudden cardiac death from left ventricular hypertrophy.ft ventricular hypertrophy.

In hypertension, the heart may increase to 600 g or morIn hypertension, the heart may increase to 600 g or more and the muscle mass thus outgrows it coronary supply, evee and the muscle mass thus outgrows it coronary supply, even if the coronary arteries are healthy.n if the coronary arteries are healthy.

Atheroma is often associated with hypertension, so that Atheroma is often associated with hypertension, so that the enlarged muscle mass is further deprived of even a normthe enlarged muscle mass is further deprived of even a normal flow and becomes ischemic. Such muscle is unstable and iral flow and becomes ischemic. Such muscle is unstable and irritable and easily jumps into arrhythmias and fibrillation, writable and easily jumps into arrhythmias and fibrillation, which causes the sudden death of an individual.hich causes the sudden death of an individual.

(2) Hypertensive heart disease(2) Hypertensive heart disease

This condition may lead to sudden cardiac death from leThis condition may lead to sudden cardiac death from left ventricular hypertrophy.ft ventricular hypertrophy.

In hypertension, the heart may increase to 600 g or morIn hypertension, the heart may increase to 600 g or more and the muscle mass thus outgrows it coronary supply, evee and the muscle mass thus outgrows it coronary supply, even if the coronary arteries are healthy.n if the coronary arteries are healthy.

Atheroma is often associated with hypertension, so that Atheroma is often associated with hypertension, so that the enlarged muscle mass is further deprived of even a normthe enlarged muscle mass is further deprived of even a normal flow and becomes ischemic. Such muscle is unstable and iral flow and becomes ischemic. Such muscle is unstable and irritable and easily jumps into arrhythmias and fibrillation, writable and easily jumps into arrhythmias and fibrillation, which causes the sudden death of an individual.hich causes the sudden death of an individual.

(3) Primary myocardial disease(3) Primary myocardial disease

This is much less common than the ischemic condition oThis is much less common than the ischemic condition of the heart. It may include several kinds of myocardial lesif the heart. It may include several kinds of myocardial lesions. ons.

MyocarditisMyocarditis that occurs in many infective diseases, such that occurs in many infective diseases, such as diphtheria and virus infections including influenza, dissas diphtheria and virus infections including influenza, disseminated sarcoidosis ( myocardial sarcoidosis). eminated sarcoidosis ( myocardial sarcoidosis).

In sudden death pathology, a myocarditis of unknown aIn sudden death pathology, a myocarditis of unknown aetiology is sometimes discovered on histology of autopsy tietiology is sometimes discovered on histology of autopsy tissues, known as isolated, Fiedler’s or Saphir’s myocarditis.ssues, known as isolated, Fiedler’s or Saphir’s myocarditis.

MyodarditisMyodarditisMyodarditisMyodarditis

MyodarditisMyodarditisMyodarditisMyodarditis

CardiomyopathyCardiomyopathy, where a large heart shows certain abn, where a large heart shows certain abnormal histological characteristics, includingormal histological characteristics, including ：： HCM HCM (hypertrophic cardiomyopathy), (hypertrophic cardiomyopathy), : huge hearts of ov: huge hearts of over 1000 g; asymmetric massive thickening of ventricular walls.er 1000 g; asymmetric massive thickening of ventricular walls.

CCM CCM (congestive cardiomyopathy) (congestive cardiomyopathy) : dilatation of the cha: dilatation of the chambers with thinning of the ventricular walls.mbers with thinning of the ventricular walls.

RCM RCM (restrictive cardiomyopathy )(restrictive cardiomyopathy ): evident fibrotic thick: evident fibrotic thickening of the endomyo-cardium.ening of the endomyo-cardium.

ARVD/C ARVD/C (arrhythmogenic right ventricular cardiomyopat(arrhythmogenic right ventricular cardiomyopathy(dysplasia)) hy(dysplasia)) : displacement of myocardial fibers by fatty tissu: displacement of myocardial fibers by fatty tissue and collagen fibers.e and collagen fibers.

2. Central nervous system2. Central nervous system(1) Ruptured berry aneurysm(1) Ruptured berry aneurysm

Subarachnoid hemorrhage: a relatively common cause Subarachnoid hemorrhage: a relatively common cause of sudden collapse and often rapid death in young to middle-of sudden collapse and often rapid death in young to middle-aged people, due to a ruptured aneurysm of a basal cerebral aged people, due to a ruptured aneurysm of a basal cerebral artery. artery.

Berry aneurysms develop at a weak spot in the vessel Berry aneurysms develop at a weak spot in the vessel wall, which may be of any size from a millimeters to several wall, which may be of any size from a millimeters to several centimeters in diameter and may be single or multiple. The centimeters in diameter and may be single or multiple. The apex can rupture, especially at any sudden rise in blood apex can rupture, especially at any sudden rise in blood pressure, such as from exercise or emotion.pressure, such as from exercise or emotion.

Ruptured berry aneurysmRuptured berry aneurysmRuptured berry aneurysmRuptured berry aneurysm

(2) Cerebral hemorrhage(2) Cerebral hemorrhage

Sudden bleeding into the brain substance is common, Sudden bleeding into the brain substance is common, usually in old age and in those with significant hypertension. usually in old age and in those with significant hypertension.

The hemorrhage most often takes place in the external The hemorrhage most often takes place in the external capsule of one hemisphere from rupture of a lenticulo-striate capsule of one hemisphere from rupture of a lenticulo-striate artery. The sudden expansion of a hematoma compresses the artery. The sudden expansion of a hematoma compresses the internal capsule and may destroy some of it, leading to a internal capsule and may destroy some of it, leading to a hemiparesis. hemiparesis.

Other places where bleeding occurs include the Other places where bleeding occurs include the cerebellum and mid-brain. Some bleedings in the brain-stem cerebellum and mid-brain. Some bleedings in the brain-stem may lead to marked hyperpyrexia. may lead to marked hyperpyrexia.

Figure 17.5 A large intracerebral haemorrhage in the internal capsule, with extension into the ventricle.

Figure 17.6 Pontine haemorrhage in a hypertensive individual.

Subarachnoid hemorrhage and cerebral hemorrhageSubarachnoid hemorrhage and cerebral hemorrhageSubarachnoid hemorrhage and cerebral hemorrhageSubarachnoid hemorrhage and cerebral hemorrhage

cerebral hemorrhagecerebral hemorrhagecerebral hemorrhagecerebral hemorrhage

pone hemorrhagepone hemorrhagepone hemorrhagepone hemorrhage

(3) Cerebral thrombosis and infarction(3) Cerebral thrombosis and infarction

This is rarely a cause of sudden or unexpected death, This is rarely a cause of sudden or unexpected death,

as the process is relatively slow, though neurological as the process is relatively slow, though neurological

symptoms and signs consequent on infarction of a symptoms and signs consequent on infarction of a

substantial part of the brain may be severe.substantial part of the brain may be severe.

3. Respiratory system3. Respiratory system

The major cause of sudden death within the respiratory The major cause of sudden death within the respiratory organ is again vascular. organ is again vascular. Pulmonary embolism Pulmonary embolism In almost every case, the source of the emboli is in the leIn almost every case, the source of the emboli is in the leg veins and pelvic veins. After any tissue trauma, or even surg veins and pelvic veins. After any tissue trauma, or even surgical operation, especially where immobility or bed rest occugical operation, especially where immobility or bed rest occurs, deep vein thrombosis develops. rs, deep vein thrombosis develops. Other rare causes of sudden death in the respiratory sysOther rare causes of sudden death in the respiratory system include a massive hemoptysis from cavitating pulmonartem include a massive hemoptysis from cavitating pulmonary tuberculosis or from a malignant tumor, though the latter iy tuberculosis or from a malignant tumor, though the latter is a rare complication.s a rare complication.

pulmonary tuberculosispulmonary tuberculosispulmonary tuberculosispulmonary tuberculosis

pulmonary tuberculosispulmonary tuberculosispulmonary tuberculosispulmonary tuberculosis

pulmonary pneumoniapulmonary pneumoniapulmonary pneumoniapulmonary pneumonia

pulmonary pneumoniapulmonary pneumoniapulmonary pneumoniapulmonary pneumonia

pneumothoraxpneumothoraxpneumothoraxpneumothorax

4. Gastrointestinal system4. Gastrointestinal system

Once again, causes of death in this system may be Once again, causes of death in this system may be vascular, in that very severe bleeding from a gastric or vascular, in that very severe bleeding from a gastric or duodenal peptic ulcer can be fatal in a short time, but most duodenal peptic ulcer can be fatal in a short time, but most are moderate enough to allow medical or surgical treatment.are moderate enough to allow medical or surgical treatment.

Perforation of a peptic ulcer can be fatal in hours if not Perforation of a peptic ulcer can be fatal in hours if not treated and intestinal gangrene due to strangulated hernias treated and intestinal gangrene due to strangulated hernias and torsion due to peritoneal adhesions can also be and torsion due to peritoneal adhesions can also be fulminating and fatal conditions.fulminating and fatal conditions.

Nodal hepatocirrhosisNodal hepatocirrhosis

Gastric hemorrhageGastric hemorrhage

Acute necrotic pancreatitisAcute necrotic pancreatitis

Acute necrotic pancreatitisAcute necrotic pancreatitis

Gastric perforationGastric perforation

Bacteria diarrheaBacteria diarrhea

5. Genitourinary system5. Genitourinary system If a woman in child-bearing age is found unexpectedly If a woman in child-bearing age is found unexpectedly death, a complication of pregnancy must be considered.death, a complication of pregnancy must be considered.

Abortion is one possibility, especially in countries where Abortion is one possibility, especially in countries where illegal abortion is still very common. In these cases death from illegal abortion is still very common. In these cases death from vagal shock, hemorrhage and infection from septic vagal shock, hemorrhage and infection from septic instrumentation and possibly air embolism must be considered.instrumentation and possibly air embolism must be considered.

A ruptured ectopic gestation, usually tubal in position, is A ruptured ectopic gestation, usually tubal in position, is another grave emergency that can be fatal due to another grave emergency that can be fatal due to intraperitoneal bleeding, unless rapidly treated by surgical intraperitoneal bleeding, unless rapidly treated by surgical intervention.intervention.

ectopic gestationectopic gestationectopic gestationectopic gestation



amniotic fluidamniotic fluid embolism embolismamniotic fluidamniotic fluid embolism embolism





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Sudden and Unexpected Death from Natural Causes