J.Jpn. Surg. Soc.. 82(10): 1188-1198, 1981

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Original article

PATHOLOGIC ANATOMY OF SHOCK SYNDROME

Eighty autopsy cases of the so-called Ekiri (or Reye's syndrome) and 10 cases of the so-called Pokkuri disease (sudden death of adult) were subjected to morbid-anatomical and histological examinations of several organs including the liver, kidney, stomach, spleen, lung, heart and pancreas, in order to establish a criteria of shock for autopsy diagnosis.
It was disclosed that the major lesions characteristic to these syndromes were, in order of diminishing frequency; liver: pericapillary edema and/or centrolobular necrosis with or without gallbladder edema, stomach and duodenum: pale anemic gastric mucosa, hemorrhagic erosion and/or ulcer, coffee-ground-like contents, spleen: perifollicular P M N, kidney: pyknosis and/or disintegration of epithelial cells of distal convoluted tubules, lung: intra-alveolar and/or interstitial edema. All of these were ascribed to anoxia due to arterial reactions.
An additional examination of 2,825 indiscriminate autopsy cases ensured the above combination of lesions also to characterize the shock of miscellaneous causes such as cardiogenic, hypovolemic shock etc, thus serving as morphological stigmata of shock syndrome.
Correlative analysis between different organ lesions revealed the combination of hepatic, gastric and splenic lesions to be the most typical, which was however quite inconsistent with the general assumption that the renal and pulmonary lesions might represent the pathology of this syndrome.

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