The Case of the Corpulent Commander Who Sustained a Fatal Fall

Albert B. Lowenfels, MD; Jennifer Dore, MD

Disclosures

February 19, 2008

Introduction

The patient was a 59-year-old morbidly obese male military officer, a member of a prominent family, who was injured while fighting a successful battle against enemy troops. The battle took place at the end of July. While riding his horse through the dying embers of the battlefield, his mount suddenly reared, unexpectedly forcing the patient against the sharp protruding pommel of his saddle.

Because of the onset of sudden abdominal pain, his followers immediately suspected that he had sustained a serious internal injury. They took him to a nearby city where he was placed in bed so that he could rest, with the hope and expectation that he would regain his health.

Medical and Family History

At age about 35 the patient had nearly died from a sudden, severe illness of unknown nature. At age 38, after an important and successful battle, he had an attack of "dysentery," which lasted for several weeks.

The patient's father died at about 30 years of age while visiting a foreign country. His mother died in her 40s. The exact causes of death are unknown. The patient had 2 half brothers without any known diseases.

Physical Examination. The patient was an extremely obese male of medium height in obvious distress from abdominal pain. There were no abdominal scars and no evidence of a penetrating abdominal injury.

Course. The patient was eventually transferred to a nearby small, quiet hilltop town to escape the summer heat. His physicians were concerned about the continuing abdominal pain and the general deterioration of the patient's health. His abdominal pain continued throughout the month of August, although on the last day of his life, the pain appeared to subside somewhat. Nevertheless, he died after awakening at daybreak in early September -- about 6 weeks after the initial onset of abdominal pain. When it was time to transfer the body to the coffin, it was too large to fit. Attempting to squeeze the corpse into the narrow coffin caused a huge abdominal abscess to burst, permeating the room with a terrible stench.

Who was the patient?

  1. Charlemagne

  2. William the Conqueror

  3. Napoleon

  4. Alexander the Great

  5. Mark Antony

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What were the possible causes of his final illness?

  1. Appendicitis

  2. Ruptured spleen

  3. Rupture of the bladder

  4. Rupture of the bowel

  5. Traumatic pancreatitis

View the correct answer.

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