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Pediatr Radiol (2011) 41:15951597 DOI 10.1007/s00247-011-2061-z
CASE REPORT
Postmortem gastric perforation (gastromalacia) mimicking abusive injury in sudden unexplained infant death
Andrew N. Laczniak & Yutaka Sato & Marcus Nashelsky
Received: 27 October 2010 /Revised: 7 February 2011 /Accepted: 4 March 2011 /Published online: 24 May 2011 # Springer-Verlag 2011
Abstract Gastromalacia is a postmortem autolysis of gastric tissue that can culminate in gastric perforation. This entity is well-recognized by pathologists but is rarely encountered by diagnostic radiologists. We are reporting a case of sudden unexplained infant death (SUID) in which a boy was found to have pneumoperitoneum on postmortem radiographs, subsequently proved by autopsy to be caused by postmortem gastric perforation resulting from gastromalacia. It is important for radiologists to recognize this entity so as not to mistake it for bowel perforation caused by antemortem pathology, including inflicted trauma.
Keywords Gastromalacia . Postmortem artifact .
Child abuse . Intestinal perforation
Introduction
Gastromalacia is a postmortem dissolution of the stomach caused by endogenous enzymes resulting in gelatinous thinning and softening of the stomach wall with possible focal perforation. It was originally described in the 18th century by John Hunter [1] and is often associated with
intracranial disorders of various types. Gastromalacia is potentially facilitated by bacteria and is not associated with an inflammatory response of the affected gastric wall or adjacent peritonitis [2]. Gastromalacia is frequently encountered at the gastric fundus near the gastroesophageal junction. At autopsy, the finding is readily recognized as a postmortem artifact because of the typical gray discoloration and soft consistency of the thinned gastric tissue adjacent to the perforation and the lack of vital reactions including peritonitis, hemorrhage or mucosal inflammation [3]. It is a well-recognized phenomenon at autopsy by forensic pathologists but is less well known to general pathologists and diagnostic radiologists [4]. However, radiologists involved in forensic radiology should be aware of this postmortem artifact so as to avoid misdiagnosis. We present a case of sudden unexpected death in a 3-month-old boy who died of an undetermined cause. Survey radiographs prior to autopsy demonstrated a massive pneumoperitoneum, which raised concern for perforation of a hollow viscous after blunt force abdominal injury. However, subsequent autopsy found no evidence of an antemortem injury or disease process in the...