A 5-year-old boy with an unremarkable personal history and adequate paediatric control. The parents only emphasised that he was a child who did not eat much. A week before the incident, he presented with an upper respiratory tract cold without fever or other associated signs. The parents report that he also presented non-specific abdominal discomfort, accompanied by increased bowel sounds and nausea without vomiting. He was assessed by his local paediatrician, who found no specific pathology and prescribed a soft diet. At 0 hours on the day of death, the child woke up with unfocused abdominal pain. Over the next few hours, he felt nauseous and had several episodes of vomiting, first of food and finally mucous vomiting with no hematic or bilious traces. At 5 a.m., he was found to be weak and cold and was given a hot bath, and in the bath he was found to be unresponsive to stimuli. The assistance of an emergency team was requested, who found him in cardiorespiratory arrest and started CPR manoeuvres without success.
A legal autopsy was performed. He was a normal male child, 1.17 m tall, with no signs of obesity or malnutrition, with pale skin and mucous membranes. A complete autopsy was performed with opening of the three cavities and the anterior cervical plane, following the recommendations of the Council of Europe [1]. No significant pathological alterations or developmental anomalies were observed.
During the autopsy, the examination of the abdominal cavity revealed a collection of serohaematic fluid of approximately 0.5 litres. The stomach shows little food debris with no haematic traces, coffee grounds or bilious debris. The walls of the duodenum are preserved and the intestinal contents are normal. About 20 cms from the duodeno-jejunal angle, the colour of the intestinal walls turns dark red, maintaining this colour change until about 5 cms from the ileo-caecal valve. This last segment of the ileum is clearly narrowed with fibrous changes. Inside the segment of small intestine with parietal changes, there is a haematic content of approximately 1.5 litres.

The position of the intestinal loops is altered by the presence of an anomaly in the closure of the mesentery of the cecum. There is an eyelet of about 3 cm in diameter located immediately next to the cecum, through which the extensive passage of the small intestinal loops and part of the descending colon can be seen, which is dilated and lateralised to the right and interrupted in its course by the passage through the eyelet, continuing towards the rectum from the said eyelet.

The cause of death is estimated to be haemorrhagic shock secondary to mechanical obstruction and necrosis of the small intestine due to transmesocolic hernia with internal herniation of the small and large intestine.