Fatal Blunt Pancreatic Trauma and The Vertebral Anvil Mechanism: A Single-Case Forensic Autopsy Report

Abstract

Background. Blunt pancreatic injury is uncommon, and fatal cases after unarmed assault are rarely documented with combined autopsy, histological and toxicological data. Compression of the gland against the lumbar vertebral bodies (the “vertebral anvil effect”) has been proposed as the mechanism of transection.

Objective. To describe the autopsy findings in a fatal blunt pancreatic injury after a reported assault and to assess whether a simple mechanical estimate supports vertebral compression as the mechanism.

Methods. This single-case forensic autopsy study followed the CARE (CAse REport) guideline. A 21-year-old man was examined by Letulle en masse evisceration at police request. Injuries were mapped, specimens were screened by chromatography and mass spectrometry, and pancreatic histology was scored semiquantitatively. Impact energy and force were estimated from assumed inputs.

Results. A 12.0 × 8.5 cm epigastric contusion and forearm abrasions were present. The pancreas was transected at the neck–body junction with main-duct disruption and a retroperitoneal hematoma of about 350 mL; a splenic laceration with about 120 mL of hemoperitoneum was also found. Toxicology was negative. Histology showed diffuse acinar necrosis, fat necrosis and neutrophilic infiltration. The estimate gave 53–212 J and 650–2,570 N per blow; the number of blows was unknown and no sourced tissue threshold was available.

Conclusion. The findings are consistent with death from traumatic pancreatic transection with hemorrhage and secondary necrotizing pancreatitis after blunt epigastric force. The mechanical estimate is illustrative only; the mechanism is inferred from the anatomy and injury pattern. One case cannot establish the vertebral anvil effect or the survival interval.