<abstract xmlns="http://www.w3.org/1999/xhtml"><p>A 63-year-old woman underwent a nephrectomy on the right side for renal cancer. Postoperatively she developed abdominal and lower back pain, which was treated with an injection of analgesics in an epidural catheter. The following morning it was discovered that the patient had cold legs with pallor and no palpable femoral pulse. Rigor mortis and livor mortis were diagnosed in both legs, even though the patient was still alive and awake. Doppler ultrasound examination revealed the absence of blood flow in the lower part of the abdominal aorta and distally. A cross disciplinary conference including specialists in urology, orthopaedics, vascular surgery, anaesthesiology, internal medicine, and intensive care concluded that no lifesaving treatment was possible, and the patient died the following day. A forensic autopsy revealed severe atherosclerosis with thrombosis and dissection of the abdominal aorta. This case clearly demonstrates that a vascular emergency should be considered when patients complain about pain in the lower back, abdomen or limbs. Clinicians should be especially aware of symptoms of tissue death that can be masked by epidural analgesia.</p></abstract>

A 63-year-old woman underwent a nephrectomy on the right side for renal cancer. Postoperatively she developed abdominal and lower back pain, which was treated with an injection of analgesics in an epidural catheter. The following morning it was discovered that the patient had cold legs with pallor and no palpable femoral pulse. Rigor mortis and livor mortis were diagnosed in both legs, even though the patient was still alive and awake. Doppler ultrasound examination revealed the absence of blood flow in the lower part of the abdominal aorta and distally. A cross disciplinary conference including specialists in urology, orthopaedics, vascular surgery, anaesthesiology, internal medicine, and intensive care concluded that no lifesaving treatment was possible, and the patient died the following day. A forensic autopsy revealed severe atherosclerosis with thrombosis and dissection of the abdominal aorta. This case clearly demonstrates that a vascular emergency should be considered when patients complain about pain in the lower back, abdomen or limbs. Clinicians should be especially aware of symptoms of tissue death that can be masked by epidural analgesia.

Rigor mortis and livor mortis in a living patient: A fatal case of acute total occlusion of the infrarenal abdominal aorta following renal surgery

Section for Forensic Pathology and Clinical Forensic Medicine, Department of Forensic Medicine, Health, Aarhus University, Denmark

Department of Anaesthesia, Aarhus University Hospital, Denmark

Department of Urology, Odense University Hospital, Denmark

Scandinavian Journal of Forensic Science

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

A 63-year-old woman underwent a nephrectomy on the right side for renal cancer. Postoperatively she developed abdominal and lower back pain, which was treated...

Rigor mortis and livor mortis in a living patient: A fatal case of acute total occlusion of the infrarenal abdominal aorta following renal surgery

Published Online: Jul 01, 2016

Page range: 11 - 14

DOI: https://doi.org/10.1515/sjfs-2015-0004

Keywords
renal cancer, acute aortic occlusion, nephrectomy, signs of death, cause of death, rigor mortis, livor mortis

© 2016 Christian Bjerre Høyer et al., published by De Gruyter Open

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Rigor mortis and livor mortis in a living patient: A fatal case of acute total occlusion of the infrarenal abdominal aorta following renal surgery

Published Online: Jul 01, 2016

Page range: 11 - 14

DOI: https://doi.org/10.1515/sjfs-2015-0004

Keywordsrenal cancer, acute aortic occlusion, nephrectomy, signs of death, cause of death, rigor mortis, livor mortis

© 2016 Christian Bjerre Høyer et al., published by De Gruyter Open

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Keywords
renal cancer, acute aortic occlusion, nephrectomy, signs of death, cause of death, rigor mortis, livor mortis