Sudden death due to acute variceal bleeding: A review of diagnostic challenges and clinical presentation

Table 1 Comparison of acute variceal haemorrhage in in-hospital and out-of-hospital forensic presentations

Parameter	In-hospital presentation	Forensic presentation
Presentation	Haematemesis, melaena, altered sensorium or haemorrhagic shock	Sudden collapse or unexpected death
Past history	History of cirrhosis, portal hypertension	May be absent
Management	Assessment of airway, circulation and haemodynamic status, followed by resuscitation	Postmortem examination
Investigations	Upper gastrointestinal endoscopy to identify the bleeding source and provide haemostatic treatment	Gross examination for cirrhosis, splenomegaly and other features of portal hypertension, postmortem computed tomography/angiography, histopathology and toxicology