Incidental Ascariasis in a Fatal Duodenal Ulcer Perforation: A Case Report and Its Forensic Diagnostic Dilemma

Abstract

Infectious diseases are a recognized cause of peptic ulcer disease worldwide. Although peptic ulcer disease commonly follows a chronic course, it can occasionally progress to serious complications such as duodenal ulceration and gastrointestinal perforation. Perforation of the gastrointestinal tract can lead to peritonitis, a serious and potentially fatal condition that may result in sudden and unexpected death. In such situations, autopsy is essential to determine the cause of death, identify the exact site of perforation, and detect any underlying or previously undiagnosed disease. We report the case of a 27-year-old male with a five-day history of abdominal discomfort who was found unresponsive at his residence. He had earlier consulted a general practitioner, but details of the treatment given were not available. Autopsy revealed generalized peritonitis and a 0.8 cm × 0.8 cm perforated ulcer on the anterior wall of the first part of the duodenum. Histological examination showed acute-on-chronic inflammation with mucosal ulceration. Live specimens of Ascaris lumbricoides were also recovered from the small intestinal lumen, away from the perforation site, and were regarded as an incidental finding rather than the cause of perforation. This case illustrates that, in the absence of overt clinical signs, such complications may be discovered only at post-mortem examination, and underscores the forensic importance of distinguishing an incidental parasitic infestation from the true cause of death.