ABSTRACT
Prolapse rectum (PR) or protrusion of the rectum beyond the anus occurs frequently in populations at both extremes of age. In the pediatric population, in developed countries, the commonest cause for PR is thought to be cystic fibrosis (CF). Treatment options for CF include conservative management, surgical resection and fixation, suturing, and injection sclerotherapy (IS). The last is considered an attractive treatment option because it is minimally invasive. In this case report, the authors present the details about a 2-year-old female child, with PR and CF, who died after IS, using phenol as the sclerotherapeutic agent. Autopsy findings and toxicology tests performed to establish phenol toxicity are documented. The available literature is reviewed. This case report underscores the risks of using phenol for IS and emphasizes the point that the procedure is not innocuous and an adverse outcome including fatality is a possibility.
Subject(s)
Phenol/adverse effects , Rectal Prolapse/therapy , Sclerosing Solutions/adverse effects , Sclerotherapy/adverse effects , Brain Edema/pathology , Brain Infarction/pathology , Child, Preschool , Creatine Kinase/blood , Cystic Fibrosis/complications , Disseminated Intravascular Coagulation/chemically induced , Fatty Liver/pathology , Female , Forensic Pathology , Heart Arrest/chemically induced , Hemorrhage/pathology , Humans , Hypoxia, Brain/chemically induced , Lung/pathology , Myocardium/pathology , Phenol/administration & dosage , Phenol/urine , Rectal Prolapse/complications , Rhabdomyolysis/chemically induced , Sclerosing Solutions/administration & dosage , Spleen/pathologyABSTRACT
Although novel influenza A (H1N1) virus infection has assumed pandemic proportions, there are few reports of the pathologic findings. Herein we describe the pathologic findings of novel influenza A (H1N1) infection based on findings in 2 autopsy cases. The first patient, a 36-year-old man, had flu-like symptoms; oseltamivir (Tamiflu) therapy was started 8 days after onset of symptoms, and he died on day 15 of his illness. At autopsy, the main finding was diffuse alveolar damage with extensive fresh intra-alveolar hemorrhage. The second patient, a 46-year-old woman with alcoholism, was found unresponsive in a basement and brought to the hospital intoxicated and confused. Her condition deteriorated rapidly, and she died 4 days after admission. The main autopsy finding was acute bronchopneumonia with gram-positive cocci, intermixed with diffuse alveolar damage. The pathologic findings in these contrasting cases of novel influenza A (H1N1) infection are similar to those previously described for seasonal influenza. The main pathologic abnormality in fatal cases is diffuse alveolar damage, but it may be overshadowed by an acute bacterial bronchopneumonia.
