FROM EMERGENCY ROOM TO MORGUE - DEATHS DUE TO UNDIAGNOSED PERFORATED PEPTIC-ULCERS - REPORT OF 4 CASES WITH REVIEW OF THE LITERATURE

Peptic ulcer perforation is well recognized as a cause of: peritonitis and can result in death. Although amenable to surgery, delay in makin g the correct diagnosis results in increased mortality. Accurate diagn osis has been hindered by demographic changes in the affected populati on. In recent years, the population at risk has increased. Specificall y, a rising incidence has been observed in women, in the elderly, and in patients with previously undiagnosed peptic ulcer disease. Describe d are four patients with perforated peptic ulcers, three of which were not detected prior to autopsy. In three of the four instances, the pa tient had been observed in and discharged from a hospital emergency ro om during the 30 h prior to death. In the fourth case, the decedent ha d been seen in and discharged from the emergency room four times durin g the month prior to death. In all patients, the presenting historical , physical, and/or radiographic findings were indicative of perforatio n. The death of a patient within days of a visit to an emergency room should prompt a forensic autopsy. The role of medical examiners in pro viding quality assurance feedback to emergency rooms located within th eir jurisdiction is emphasized.