Veronique Campion¹, Lena Quinto²

1Sydney Medical School, University of Sydney, Camperdown, NSW 2 Forensic Medicine, Forensic and Analytical Science Service, NSW Health Pathology, Lidcombe, NSW

Intussusception is the telescoping of one segment of the bowel into an adjacent segment, leading to obstruction and ischemia, and is most common in paediatrics. Intussusception in living patients is pathological, often symptomatic and can cause death, while agonal intussusception may represent a post-mortem artefact. The latter is thought to occur due to disordered peristalsis during death [1]. Agonal intussusceptions have been recognized in autopsies for over a century and can be induced experimentally [2].  Contemporary literature, particularly in the context of Sudden Unexpected Death in Infancy (SUDI), is relatively silent. 

 

We reviewed cases of agonal intussusception in our department in Sydney over a 20-year period. Six cases were recorded. Consistent with existing literature, agonal cases show no signs of inflammation, necrosis, or adhesions. Given that the intussusceptions may be easily reduced, the phenomenon risks being missed (or reduced) during evisceration. Artefacts in death are important to recognise although intussusception may also represent a true cause of death with multiple physiological derangements [3]. While agonal intussusception is rare and not considered related to death, further research is needed to clarify the true incidence and interpretation of agonal intussusception in SUDI. 

 

1.        Treves F. Intussusception. In: Intestinal Obstruction: Its Varieties with their Pathology, Diagnosis, and Treatment. 2nd ed. London: Cassell; 1899. pp. 141-84.

2.        Treves F. The treatment of intussusception. The British Medical Journal. 1885;1(1253):6-9

3.        Byard, R. W., & Simpson, A. (2001). Sudden death and intussusception in infancy and childhood-autopsy considerations. Medicine, Science and the Law, 41(1), 41-45.