Secondary sclerosing cholangitis in critically ill patients after a traffic accident—a new entity that should be considered in death classification

A 49-year-old female sustained a polytrauma after being hit by a vehicle in a traffic accident. Following the incident, the woman had various surgical interventions and underwent intensive care over a 6-week period. Eight months later, she died after developing secondary sclerosing cholangitis (SSC)...

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Bibliographic Details
Published in:International journal of legal medicine 2018-11, Vol.132 (6), p.1729-1732
Main Authors: Zack, Fred, Nizze, Horst, Blaas, Verena, Port, Anne, Büttner, Andreas
Format: Article
Language:English
Subjects:
Accidents, Traffic
Autopsies
Case Report
Cholangitis
Cholangitis, Sclerosing - complications
Cholangitis, Sclerosing - etiology
Critical Care
Critical Illness
Fatal Outcome
Fatalities
Female
Forensic Medicine
Hepatic Encephalopathy - etiology
Hepatic Encephalopathy - pathology
Humans
Intensive care
Liver
Liver Failure - etiology
Liver Failure - pathology
Medical Law
Medicine & Public Health
Middle Aged
Multiple Trauma - complications
Multiple Trauma - etiology
Traffic accidents
Traffic accidents & safety
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Summary:A 49-year-old female sustained a polytrauma after being hit by a vehicle in a traffic accident. Following the incident, the woman had various surgical interventions and underwent intensive care over a 6-week period. Eight months later, she died after developing secondary sclerosing cholangitis (SSC). Autopsy revealed liver failure and hepatic encephalopathy due to SSC caused by the polytrauma and the subsequent intensive care. Prior to the accident, there was no evidence of a pre-existing liver or biliary system disease. The death of the patient was classified as non-natural as a causal consequence of the traffic accident. SSC has been clinically described as a complication of intensive care. Since it has a high mortality rate, it is important that forensics and pathologists are aware of the condition.
ISSN:0937-9827
1437-1596
DOI:10.1007/s00414-018-1801-0