Surgical Intervention in Septic Conditions: A Double-edged Sword Unveiled by Forensic and Histopathological Evaluation

Abstract

This case report describes a fatal instance of septicaemia following dilation and curettage (D&C) performed for retained products of conception (RPOC), highlighting its forensic and pathological significance. A 20-year-old female presented with fever, abdominal pain, and systemic symptoms, with investigations revealing severe hepatic and renal dysfunction. Ultrasonography confirmed RPOC, and surgical evacuation was performed. Despite intensive management, the patient developed progressive sepsis, multiorgan dysfunction, and ultimately succumbed to cardiorespiratory arrest. Autopsy findings revealed jaundice, pulmonary congestion with necrosis, and a uterus containing retained necrotic tissue. Histopathological examination demonstrated diffuse alveolar damage, acute tubular necrosis, endometritis with chorionic villi, myocarditis, and widespread inflammatory changes, consistent with septic multiorgan failure. The retained avascular tissue acted as a nidus for persistent infection, facilitating bacterial dissemination into systemic circulation. This case underscores the pathophysiological progression from localized uterine infection to systemic sepsis following D&C. It emphasizes the importance of early diagnosis, prompt evacuation, aggressive antimicrobial therapy, and multidisciplinary management to prevent fatal outcomes. From a medico-legal perspective, it highlights the need for vigilance in managing RPOC and recognizing complications early.