38-year-old woman diagnosed with multiple sclerosis on treatment with interferon beta and ankylosing spondylitis treated with ibuprofen and metamizole. The relative who lived with her reported that she had been unable to defecate for three days, with abdominal pain and distension. At around 01:30 hours, she administered a 240 ml enema (a so-called rectal laxative) and went to bed. At 5 a.m. the relative found her unconscious and with traces of dark green vomit on her face and around her. She was attended by the emergency medical service, who found her with signs of certain death and did not apply resuscitation measures.
Autopsy findings: height: 1.54 m; weight: 52 kg: 52 kg; body mass index, normal (21.9 kg/m2); traces of dark green fluid in nostrils, inside and around the mouth; abdominal distension; on opening the abdomen, large dilatation of the stomach and duodenum occupying most of the visible abdominal cavity, reaching down to the lesser pelvis ; the remaining abdominal viscera are hidden by the stomach, which is completely filled with dark green fluid (bile and a few haematic remains in the form of "coffee grounds"); the walls of the stomach are thinned and with areas of haemorrhagic appearance in the mucosa; the stomach contains 3.5 litres of dark green fluid; gastric contents in the airway.

Histopathological study diagnosed, in the stomach, congestion in the vessels of the lamina propria and autolysis of the glandular epithelium; in the brain, inactive plaques of multiple sclerosis; and bronchoalveolar aspiration.

Toxicological screening only detected sub-therapeutic concentrations of metoclopramide, ibuprofen and diazepam.

