A rare case of splenic injury due to a chest drain

iatrogenic splenic injury is a recognized complication in diagnostic and therapeutic procedures performed on the gut (e.g., colonoscopy, colon surgery). however, iatrogenic splenic injury following other types of medical and surgical interventions have also been described in the literature. Spleen injury after chest tube insertion is a very rare event that must be investigated to assess medical error and liability. We present the case of a 68-year-old woman who underwent to thoracentesis for a pleural effusion. about 20 hours after, blood tests showed a marked decrease in the hemoglobin concentration (7.0 g/dL) and hematocrit (21%). repeat abdominal ultrasonography showed a perisplenic hematoma and hemoperitoneum, and an emergency splenectomy was performed. The patient was admitted to the intensive care unit. her clinical condition subsequently worsened, particularly her renal and cardiac function, and she died 6 days after surgery. As in this case iatrogenic lesions represent a field of interest for the forensic pathologist. The medicolegal investigation in such situations aims to assess the presence of elements compatible with profiles of professional responsibility of personnel involved in diagnostic and therapeutic procedures. In our case, the autopsy provided useful data to evaluate the pathophysiological processes underlying the splenic lesion

Synergic action of high midazolam doses and morphine in terminal cancer patient: indications, criticality and liability

Introduction and Aims Palliative care were introduced in Italy in 2010, while in 2007 the Italian Society Palliative Care (S.I.C.S.) published recommendation on terminal/palliative sedation, defining the taxionomic, pharmacological and therapeutic aspects. However, the definition of the most suitable therapy for an effective sedation still represents one of the most challenging goals in medical practice. The case of a terminal cancer patient is presented, focusing on the “adequacy” of administered therapy. Materials and Methods A young male, affected by Ewing sarcoma, attending a palliative care at his own home, died soon after midazolam administration. Toxicological and histological analyses were performed on body fluids and organ fragments. Results and Discussion Toxicological analyses evidenced blood midazolam concentrations in the range 0,931-1,690µg/mL, while morphine was between 0,266-0,909µg/mL. Morphological reliefs evidenced a mammellon tissue, of lardous consistency and greyish-pink color, in the sacrum region (S1-S5), at the anterior mediastinum level, the entire left pleural cavity, infiltrating the ipsilateral lung. Metastatic lesions diffused to rachis and lumbar structures. Brain presented edema and congestion. The pharmacological interaction between midazolam and morphine are reviewed, considering the clinical situation of the patient, the amount and specific way of administration of the benzodiazepine. The opportunity to proceed with midazolam administration is discussed starting from S.I.C.S. recommendation. Finally, professional responsibility outlines are highlighted