Gastrointestinal Pathology

Abstract

Fatal outcomes with gastrointestinal (GI) diseases may be associated with natural death by GI hemorrhage or with surgical operations in the clinical setting. This possibility involves the role of clinical pathology as well as, in the case of alleged malpractice, forensic medicine. If postmortem imaging methods include postmortem CT angiography (PMCTA), they allow an excellent opportunity to confirm clinical findings or to supplement them. The localization of GI bleeding sources may be complicated by artificial contrast extravasation in the gastric and duodenal mucosa, which is enhanced in cases with multiorgan failure and longer postmortem periods. A major benefit of PMCTA visualization is the analysis of the mesenterial and portal vein vasculature regarding their patency. In visceral and transplantation surgery, sometimes collateral blood supply caused by occlusion of central parts of the celiac trunk or superior mesenteric artery can be evaluated regarding its functional importance after vascular interventions. Contrary to autopsy findings, sometimes multiple GI hemorrhage sources can be detected by PMCTA, facilitated by multiphase methods that allow distinction of an origin in the arterial and venous systems. Typical complications after GI surgery include suture dehiscence, accidental vessel damage, and spontaneous venous hemorrhages in patients with coagulation disorders.