Use of contrast-enhanced post-mortem computed tomography to diagnose intestinal perforation caused by malpractice: A case report

RATIONALE: The application of post-mortem computed tomography (PMCT) and PMCT angiography (PMCTA) is becoming increasingly common in forensic investigations. One of the most frequently applied techniques today is PMCTA. However, few studies have focused on the application of contrast-enhanced PMCT of hollow organs such as the gastrointestinal tract. The intestine is a special digestive organ with a complicated anatomical structure; it is difficult to separate in medicolegal investigations, during which new rupture may occur, affecting the examiner's judgment. Moreover, the formalin-fixed intestine is more difficult to separate because of its increased brittleness. In the present case, the authors applied contrast-enhanced PMCT to the diagnosis of intestinal perforation caused by a medical accident. PATIENT CONCERNS: A 67-year-old woman with cholecystitis underwent laparoscopic cholecystectomy in the hospital. The gallbladder was successfully removed, but the doctor was suspected to have accidentally perforated her intestinal tract with the laparoscopic machinery. The patient developed severe peritonitis and died after the operation. DIAGNOSIS, INTERVENTIONS, AND OUTCOMES: Contrast-enhanced PMCT with isolation of the intestinal tract was performed after dissection of the body. The results suggested that the contrast agent flowed out through the rupture. The autopsy and histological examination revealed a perforated crevasse, confirming the cause of peritonitis while excluding other probabilities despite the doctor's denial. LESSONS: Contrast-enhanced PMCT was an effective technique with which to interpret this gastrointestinal tract rupture and served as a non-invasive tool for identifying the injury.