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Modgil V, Nagar N. Sudden death due to acute variceal bleeding: A review of diagnostic challenges and clinical presentation. World J Transl Med 2026; 12(4): 128231 [DOI: 10.5528/wjtm.128231]
World J Transl Med. Nov 28, 2026; 12(4): 128231 Published online Nov 28, 2026. doi: 10.5528/wjtm.128231
Sudden death due to acute variceal bleeding: A review of diagnostic challenges and clinical presentation
Varun Modgil, Nirmal Nagar
Varun Modgil, Department of Forensic Medicine and Toxicology, ESIC Medical College Hospital, Ludhiana 141001, Punjab, India
Nirmal Nagar, Department of Forensic Medicine and Toxicology, Bharat Vikas Institute of Medical Sciences, Kota 324009, Rājasthān, India
Co-first authors: Varun Modgil and Nirmal Nagar.
Author contributions: Modgil V and Nagar N contributed to this paper; Modgil V designed the overall concept and outline of the manuscript; Nagar N contributed to the discussion and design of the manuscript; Modgil V and Nagar N contributed to writing and editing the manuscript, preparing illustrations, and reviewing the literature.
AI contribution statement: The authors take full responsibility and accountability for all content of this manuscript, including any portions for which AI tools were used as assistive technologies. All AI-assisted outputs were carefully reviewed, validated, and approved by the authors. AI tools were not used to generate original scientific data, perform independent scientific analyses, or draw scientific conclusions.
Conflict-of-interest statement: All authors declare that they have no conflicts of interest to disclose.
Corresponding author: Nirmal Nagar, MD, Department of Forensic Medicine and Toxicology, Bharat Vikas Institute of Medical Sciences, NH-27, Baran-Chittorgarh Highway (Service Lane), Behind Kota University, Kota 324009, Rājasthān, India. nagarnirmal4@gmail.com
Received: September 18, 2026 Revised: September 26, 2026 Accepted: October 30, 2026 Published online: November 28, 2026 Processing time: 47 Days and 21.7 Hours
Core Tip
Core Tip: Sudden death due to acute variceal bleeding is an uncommon but potentially fatal complication of portal hypertension that may occur without a previously diagnosed liver disease. The diagnosis can be particularly challenging in out-of-hospital deaths, where clinical information and endoscopic confirmation are unavailable. This review highlights the varied clinical presentations, mechanisms of catastrophic haemorrhage, and important diagnostic pitfalls. Careful scene investigation, systematic autopsy examination, histopathology, and clinicopathological correlation are essential for establishing the cause of death and excluding alternative sources of gastrointestinal haemorrhage. Greater awareness among clinicians and forensic pathologists may improve diagnostic accuracy and cause-of-death certification.
