![]() This might be the mechanism which initiates the sensation of defecation in the other five cases as the emboli passes through the pelvic venous system en-route to the pulmonary artery. 17, 18 The migration of these pelvic emboli from the pelvic venous drainage system, or prostate venous plexus may be responsible for the initiation of the feeling of defecation and their sub sequent fatal pulmonary embolism. 15, 16 This might have been the case in the patients above that had radical prostatectomy, and hip fixation. Pulmonary embolism may arise from pelvic veins thrombosis. Two patients in this series suffered deep vein thrombosis. Pulmonary embolism usually arises from deep veins in the lower extremities. The authors have coined this entity of the Bed Pan Syndrome to include all patients who suffer pulmonary embolism in association with the act of defecation. This undocumented event was often referred to as the Bed Pan Syndrome in our clinical setting. 12‒14Īmongst post-partum patient it was observed that a number had fatal pulmonary embolism following call for and usage of the bedpan. 11 It is awell-known fact that venous thrombosis and pulmonary embolism occurs with increase frequency amongst post partum patients. 10 In all cases of pulmonary embolism Virchow’s triad, for thrombogenesis in veins namely hypercoagulability, stasis and intimal injury are met. ![]() In our study three patients with the bedpan syndrome suffered from diabetes mellitus. 9ĭiabetes mellitus and Hypertension have been reported as cor-morbidities in pulmonary embolism. In many instances it occurs without an underlying clinical condition and amongst these patients lupus anticoagulant and antiphospholipid antibodies are sometimes present. The clinical conditions frequently recorded in which pulmonary embolism occurs are deep vein thrombosis, following long journey in confined spaces such as aircrafts, post surgery, atrial fibrillation, congestive cardiac failure, sickle cell anemia 6dehydration, during treatment with antipsychotics, 7 oral contraceptive usage, 8 and hypercoaguable states. 2‒5 Pulmonary embolism often presents with chest discomfort, tightness, pain and difficulty in breathing. Pulmonary embolism is a frequent cause of death in a hospital setting and has a reported incidence as high as 10.88%-12.6%. Keywords: pulmonary embolism, bed pan syndrome, act of defecation, autopsy Introduction Pulmonary embolism associated with the act of defecation is seldom reported in the medical literature and the seven (7) such cases are the subject of discussion in this presentation. Diabetes Mellitus and Essential hypertension were cor-mobidities in 42.9% of cases. The mean age of patient in this study was 64.7 years. ![]() Seven cases or 8.6% of those dying from pulmonary embolism, died suddenly during the act of defecation. During the period of study 1778 autopsies were performed and eighty one (81) deaths were recorded as pulmonary embolism, which represented 4.6% of the cause of death during the period of study. A retrospective autopsy study for the three years 2015-2017 was done on all deaths reported as pulmonary embolism. The authors report on seven cases of fatal pulmonary embolism that occurred during or after defecation, which they referred to as the Bed Pan Syndrome. Pulmonary embolism as the cause of death is frequent in a hospital setting.
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