Fatal case with fish bone: syncope causes and deontological aspects of patient management

Abstract

A clinical case of a patient G., 30 years old, who choked on a fish bone on the last day of being in prison, is described. The prison doctor and then the local doctor did not conduct special investigations and esophagus damage by the fish bone was virtually dismissed. Then, the patient presented with fever (39 °C) and chills. Diagnosis of «influenza» was made. A few days later, tonic-clonic seizures with loss of consciousness appeared. Diagnosis of «Epilepsy?» was made. The patient was admitted to the therapeutic hospital via ambulance on the 7th day of the disease. In 60 minutes after admission the patient died of profuse arterial esophageal bleeding. At autopsy there was purulent lesion of the thoracic esophagus posterior wall, purulent mediastinitis, purulent fusion of the anterior wall of the aorta, aortoesophageal fistula. Tonic-clonic seizures with the syncope development in a patient G. emerged as a manifestation of the condition such as the Morgagni-Adams-Stokes syndrome due to hemodynamically induced cerebral ischemia, which occurred because of the blood leakage from the aorta into the esophagus through the festering aortoesophageal fistula. Fatal case could be avoided, when following deontological principles of treating and the presence of doctors’ professionalism.