Forensic Pathology for Police - Brainshare Public Online Library

Gastrointestinal and Hepatobiliary System 239
something protrudes into or through something that it should not. Examples of
herniation sites involving segments of bowel (usually small intestine) include the
inguinal regions (groin), the anterior abdominal wall, a defect within the mesentery,
and intra-abdominal adhesions (which develop following surgery). A segment of
herniated bowel can become entrapped (“incarcerated”) (Fig. 10.25). It can subsequently
twist on itself, or otherwise swell to such an extent that its blood supply is
cut off. When this occurs, the hernia is said to have “strangulated.” A strangulated
hernia will eventually die (infarct), and perforation, inflammation, hemorrhage, or
sepsis, with possible death, can occur. Segments of bowel can undergo ischemic
infarction, with similar results. In some persons, the bowel actually telescopes on
itself, which can lead to compression of blood vessels with infarction, perforation,
etc. This process is referred to as “intussusception.” When a segment of bowel twists
on itself, or its mesentery, with eventual infarction, the condition is referred to as a
“volvulus.” Intussusception and volvulus may occur in association with a tumor,
which acts as a mass that predisposes to the conditions. Alternatively, each of these
conditions can occur in the absence of a tumor in children.
Fig. 10.25 A strangulated hernia case. Note that a portion of small intestine has herniated through
a small defect in the abdominal wall and that it cannot be removed. The arrow indicates where the
intestine enters the defect in the abdominal wall
Hemochromatosis
Hemachromatosis refers to excess levels of iron in the body . It can result from
a genetic abnormality (primary or hereditary hemochromatosis) or from various
iron-overload conditions, including multiple blood transfusions, various blood/bone
marrow disorders, increased oral intake of iron, and chronic liver diseases. Humans
are at risk for the disorder because they have no normal way in which to get
rid of excess iron. The genetic condition is an autosomal recessive disorder (see
below), caused by a mutation of the HFE gene, which normally regulates intestinal
absorption of iron. In primary hemochromatosis, too much iron is absorbed. The