Elsevier

Legal Medicine

Volume 40, September 2019, Pages 17-21
Legal Medicine

Sudden death and hydatid cyst: A medicolegal study

https://doi.org/10.1016/j.legalmed.2019.07.001Get rights and content

Highlights

  • Hydatid disease is endemic in North Africa countries especially in Tunisia.

  • Sudden death with a hydatid cyst discovered at autopsy leads to his implication in death.

  • Intact hydatid cyst at autopsy cannot rise the implication of the cyst in death mechanism especially by anaphylaxis.

  • Anaphylaxis is the most common mechanism of death during hydatid cyst.

Abstract

The discovery of a hydatid cyst at autopsy poses the problem of its involvement in the mechanism of death.

The aim of this study is to analyse the epidemiological and etiopathogenic characteristics of death attributed to hydatid disease, to discuss the mechanism of death and to propose preventive measures.

This is a retrospective descriptive study of 26 cases of death with hydatid cyst autopsic discovered, collected at the forensic department of Fattouma Bourguiba University Hospital of Monastir (Tunisia) over a period of 27 years (from 1990 until 2017).

In 26 cases, hydatid cyst was observed during autopsy of sudden death cases, which corresponds to 0.33% of the total of autopsies in this period. Of the 26 victims, 13 (50%) were men; the mean age was 43 years.

Most victims were from rural zones (18 cases).

In 20 cases, the complicated cyst was hepatic. It was cardiac in two cases. Of all cases, three cysts were cracked, and nine were broken. Of the 26 cases, only 15 were implicated in the death mechanism. Death was attributed to anaphylaxis in 12 cases, hydatid pulmonary embolism in 1 case, cardiac arythmia in one case and hemothorax in one case.

Sudden death is the most dangerous complication of the hydatid cyst which can be discovered at autopsy. Several causes may explain its occurrence, the most common of which is anaphylactic shock.

Introduction

Echinococcosis, also known as hydatid disease, is a human infection that is caused by the larval stage of Echinococcocus granulosus. It is a parasite disease which is common in several regions of the world, e.g., the Mediterranean countries, the Middle East, South America, East Africa, as well as some areas in Canada and Australia [1]. In Tunisia, Hydatidosis is an endemic disease as the annual average incidence within the general population is estimated to be 1.67 cases per 100.000 inhabitants per year (Ministry of Public Health, unpublished data). This infection is characterized by its high clinical latency. Patients are generally asymptomatic during long periods [2], [3]. The natural history of the disease can be enameled by several complications. Sudden death is the most dreadful one. The discovery of a hydatid cyst at autopsy poses the problem of its involvement in the mechanism of death. The role of the hydatid cyst in the mechanism of death is sometimes difficult to determine, especially in the presence of a macroscopically intact cyst. In fact, the presence of microcracking, which is highlighted by the histologic exam, can implicate the cyst in the mechanism of death especially when no other cause of the death is found.

The aim of this study is to analyse the epidemiological and etiopathogenic characteristics of death attributed to hydatid disease and to discuss the mechanism of death.

Section snippets

Materials and methods

This is a retrospective descriptive study of 26 cases of death with hydatid cyst autopsic discovered, collected at the forensic department of Fattouma Bourguiba University Hospital of Monastir (Tunisia) over a period of 27 years (from 1990 until 2017).

A data collection sheet was used based on deceased’s families, judicial investigation data, external body examinations and autopsies. In each case, we have studied the following variables:

  • -

    Epidemiological criteria: age, sex, origin, medical history

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Cases characteristics

During the study period, we performed a total of 7808 autopsies. In 26 cases, hydatid cyst was observed during autopsy of sudden death cases, which corresponds to 0.33% of the total of autopsies in this period.

Of the 26 victims, 13 (50%) were men. The mean age was 43 years. Most victims were from rural zones (18 cases). The majority of victims were jobless (nine cases) and in seven cases were farmers. A summary of cases characteristics is shown in Table 1.

Death circumstances

Of the 26 cases, only 17 presented

Discussion

This is a retrospective descriptive study conducted in the forensic department of Fattouma Bourguiba University Hospital of Monastir (Tunisia). We performed a total of 7808 autopsies over a period of 27 years (from 1990 until 2017). During this period, hydatid cysts were observed during autopsy of sudden death in 26 cases, which corresponds to 0.33% of the total of autopsies in this period. A Tunisian study performed in the Forensic Medicine Department of the Charles Nicolle Hospital (Tunis)

Conclusion

Hydatid disease may remain asymptomatic. The liver localization is the most common one. When we find a hydatid cyst at autopsy, his implication in the death is not in all cases certain especially when death is attribute to anaphylaxis.

Declaration of interest

The authors declare that they have no conflict of interest.

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