Toxic_Megacolon_Forensic_With_Images.pptx

Toxic megacolon a forensic medicine perspective

1. Toxic Megacolon – A Forensic Medicine Perspective Presenter: DR.ROSHAN RAJU VYASABHAT-2 ND YR PG Guide : DR.CH.SANDEEP-ASSISTANT PROFESSOR Institution: GANDHI MEDICAL COLLEGE,SECUNDERABAD Event: Paper Presentation – TGAFMCON-2025

2. Introduction Toxic megacolon is a rare, life-threatening complication of colonic diseases. Characterized by acute colonic distension with systemic toxicity. From a forensic standpoint, often associated with sudden and unexplained death.

3. Objectives Understand the pathophysiology and causes of toxic megacolon . Explore the medicolegal implications of undiagnosed or mismanaged cases. Discuss autopsy findings and forensic significance.

4. Definition Toxic megacolon : Acute toxic colitis with severe colonic dilatation (usually >6cm). Associated with systemic toxicity. Can occur in IBD (especially ulcerative colitis), infections, or ischemic bowel.

5. Etiology Inflammatory: Ulcerative colitis, Crohn’s disease Infective: Clostridium difficile , CMV colitis Ischemic: Vascular compromise Toxicological: Anticholinergics , narcotics, antipsychotics

6. Pathophysiology Inflammatory response leads to paralysis of smooth muscle. Accumulation of gas and fluid in colon. Risk of perforation, peritonitis, sepsis, and death.

7. Clinical Features Abdominal pain, distension Fever, tachycardia Diarrhea (bloody), altered sensorium Signs of septicemia

8. Forensic Relevance Often presents as sudden death, especially in untreated or rapidly progressive cases. May be misdiagnosed or overlooked if no clear clinical history. Important differential in custodial deaths with abdominal symptoms.

9. Autopsy Findings Grossly distended colon (>6 cm) Thinned, necrotic colonic walls Perforation sites (if present) Fecal content mixed with blood and pus Foul smell Mesenteric congestion, serositis

10. Histopathology Ulceration of mucosa Neutrophilic infiltration Gangrenous changes Loss of mucosal and submucosal architecture

11. Medicolegal Aspects Negligence: Missed diagnosis or inadequate treatment Toxicological examination: To rule out drug-induced etiology Custodial deaths: Need thorough gastrointestinal examination Medical documentation: Crucial for defending or alleging malpractice

12. Case Study 45Years old male brought for autopsy with alleged history of found dead in room where he stay along with his friends. complained of abdominal pain since last night, took painkiller to relieve pain and slept. Found dead in morning. External : - Mild distended abdomen. Internal : - Colon enlarged in size, blackish discoloration of colon with thinning of intestinal wall. Distended with gases and watery stool, emitting foul smell, mesentery is congested. Brain, meninges & Vessels: Pale Peritoneal Cavity- About 800ml of pus stained foul smelling fluid noted . Stomach & its contents -About 100ml of pink coloured liquid noted, mucosa congested. Non Specific smell noted.

13. Conclusion Toxic megacolon is a rare but fatal condition. Forensic pathologists must consider it in unexplained abdominal deaths. Accurate autopsy and histology are essential for justice in suspected negligence or custodial death cases.

14. References Robbins Pathologic Basis of Disease Forensic Pathology by Bernard Knight Recent journal articles (e.g., J Forensic Leg Med, Gut, Lancet) National Medical Guidelines

15. Questions Thank you! Any Questions?