Wischnewski ulcers and acute pancreatitis in two hospitalized patients with cirrhosis, portal vein thrombosis, and hypothermia

Accidental hypothermia has been described in the forensic literature but re ports of occurrence in hospitalized patients are rare. Associated anatomic lesions include acute hemorrhagic pancreatitis and characteristic acute gas tric ulcers termed Wischnewski ulcers. We report here two patients with cir rhosis and ascites; one also had hepatocellular carcinoma. Portal vein thro mbosis, acute hemorrhagic pancreatitis and Wischnewski ulcers were present in both. The clinical records documented hypothermia that progressed over s everal days. Temperature nadirs of 31.0 degrees C (87.8 degrees F) and 32.2 degrees C (90.0 degrees F) were recorded in each patient, respectively, on e day before death, although each transiently reached temperatures that did not register on standard monitoring devices. This is the first report that chronicles antemortem body temperatures in hypothermic patients with Wisch newski ulcers and pancreatitis at autopsy. Also, the association of these f indings with portal vein thrombosis and cirrhosis has not been previously d escribed. We discuss this constellation of findings with regard to possible mechanistic interrelations.