A 57-year-old woman under pharmacological treatment for depression and hypertension was found dead at home.
Four days before, the patient had consulted for nonspecific abdominal pain in an emergency department, starting treatment with medication.
Autopsy findings: apart from obesity (BMI 34.9 kg/m2), the only significant finding was that the gallbladder was markedly distended and increased in size, containing a large gall bladder calculus (4.5 x 2.5 cm).
The gallbladder wall was thickened and the mucosa hyperemic with focal hemorrhage.
No purulent exudate, perforation, abscesses, fistulas or peritonitis were observed.
The cystic and choledochal ducts were permeable.
Toxicological analysis detected benzodiazepines, mianserin, ibuprofen and ketoprofen at therapeutic concentrations.
Microscopic findings: in small caliber arteries, arterioles and alveolar capillaries of the lungs numerous positive biliary emboli were identified with the Hall technique.
Biliary emboli were also identified in the liver (sinusoids and portal veins), gallbladder mucosa and spleen.
Other microscopic findings of interest were the presence of numerous fibrin thrombi in the arterioles and alveolar capillaries of the lungs and in branches of the portal vein and in sinusoids of the lungs small leukocytes the presence of focal necrosis.
Gallbladder stricture is a rare entity.
Biliary aggregates and cholesterol crystals were observed adhered to the mucosa.
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In view of these findings, biliary embolism was established as the cause of death in association with disseminated intravascular coagulation and probable sepsis.
