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- W2029286455 abstract "48-YEAR-OLD man presented at the hospital and described a 22.5-kg weight loss and progressive difficulty swallowing over the past 6 months. The following day, an esophageal biopsy showed squamous cell carcinoma. Radiographic studies indicated liver metastases. The tumor was judged to be inoperable and palliative treatment included placement of an esophageal endoprosthesis (a metallic metal mesh tube) and chemotherapy with fluorouracil and cisplatin. One week later the patient had an episode of major hematemesis and cardiopulmonary arrest that could not be reversed with resuscitation. It was apparent that the underlying cause of death was most likely esophageal squamous cell carcinoma, but the patient’s physician requested an autopsy to determine the immediate cause of death and the cause of the terminal gastrointestinal hemorrhage, with special interest in evaluating whether death resulted from a mechanical complication of the stent or its placement. AUTOPSY FINDINGS Autopsy showed an ulcerating tumor mass in the midesophagus with hepatic metastases and local infiltration into the surrounding soft tissues and substernal soft tissue. An aortoesophageal fistula existed between the posterior aortic arch and the anterior mid-upper esophagus. Two additional posterior esophageal perforations were present: 1 near each end of the stent. The stent was intact and there was no evidence that the stent itself had caused a traumatic perforation of the esophagus. The thoracic cavity did not contain blood but the esophagus and stomach contained copious blood and blood clots. Microscopic sections of each perforation site showed extensive tumor necrosis with multiple areas of tumor ulceration and an acute inflammatory infiltrate. Malignant tumor cells were identified at all levels of the esophagus that were sampled. The aortic fistula site showed acute inflammation extending from the intima through the wall and into the periadventitial soft tissues and tumor infiltrate. Based on these findings, a cause of death statement could be prepared as follows: COMMENT" @default.
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- W2029286455 date "1999-04-12" @default.
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- W2029286455 title "Unavoidable Outcomes vs Misadventures" @default.
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- W2029286455 doi "https://doi.org/10.1001/archinte.159.7.646" @default.
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