Andrew French¹, Beng Beng Ong^1
1Forensic Pathology and Coronial Services, Queensland Health

Colonic pseudo-obstruction is an uncommon condition most frequently encountered in post-surgical patients. Those affected often present with the signs and symptoms commonly attributed to a mechanical bowel obstruction, without clinical evidence of an anatomic lesion causing an obstruction. Mortality is rarely reported, but most commonly occurs due to bowel perforation or ischaemia. We report a case of death by aspiration in a 67-year-old woman who had reported several days of nausea, vomiting and abdominal distention with no background of recent surgery and an antemortem CT scan that did not show a clear obstructing lesion. She suddenly deteriorated during an episode of vomiting and was unable to be resuscitated. Post-mortem CT scan again showed no clear obstruction. Autopsy was performed, identifying a narrowed segment of large bowel with proximal dilatation and bowel loading. Copious gastric contents were identified in the lungs. Histology did not identify a clear pathological cause for the narrowing. This case represents an unusual complication of colonic pseudo-obstruction and highlights the need for identification and appropriate management.