ABSTRACT

The purpose of this case report is to discuss a case of a 72-year-old woman with chylopericardium determined at forensic autopsy, together with the medicolegal dimensions and a brief review of the literature. She presented to a hospital with gastrointestinal symptoms five days after an assault resulting in injury that could have been resolved with a simple medical intervention. Following surgical treatment of incisional hernia and perforated colonic diverticulitis, the patient’s hemodynamics were stable, and monitoring and treatment were maintained. However, the patient died on the second day of hospitalization. Autopsy revealed that the pericardium was tense and that the cavity was filled with white, chylous fluid. A surgically sutured wound, areas of ecchymosis, membrane and point hemorrhage and adhesive areas were observed in the abdomen. No significant macroscopic findings of peritonitis were observed. Histopathological examination revealed edema in the lungs, expansion of the myocyte cytoplasm in the heart, intensive neutrophil and leukocyte infiltration in the serosal surface in the small and large bowels, and nonspecific findings in addition to the suture material. No toxic substance was determined at chemical analyses. Biochemical analysis of fluid from the pericardial cavity revealed levels of 461 mg/dL triglyceride and 114 mg/dL cholesterol. Cause of death was reported as ‘‘incisional hernia, diverticular perforation, ileus and ensuing complications’’. No causal relation was established between the chylopericardium identified at autopsy and the assault occurring while the patient was alive. It was concluded that the chylopericardium developed secondary to surgical treatment.

Keywords: Blunt Trauma, Autopsy, Chylopericardium, Causal Link.