{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T06:55:04Z","timestamp":1791442504456,"version":"4.3.3"},"reference-count":10,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2026,1,18]],"date-time":"2026-01-18T00:00:00Z","timestamp":1768694400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Med Leg J"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:p>Umbilical granuloma (UG) is a benign and common umbilical anomaly in neonates and infants, typically managed conservatively with salt application or silver nitrate. While rarely requiring surgical intervention, complications arising from invasive treatments are significantly underreported. We present a rare, but fatal case, of bowel perforation following electrocautery excision of a UG in an 11-month-old male infant. The child had a persistent pinkish umbilical lesion unresponsive to conservative treatment. Ultrasonography ruled out underlying vitellointestinal anomalies, and surgical excision was performed under short general anesthaesia. The procedure was uneventful, and the infant was discharged within a few hours postoperatively. Within 24\u2009hours, the child exhibited signs of abdominal distress and was declared dead upon arrival at the emergency department. A medico-legal autopsy revealed haemoperitoneum and a perforation on the antimesenteric border of the ileum. Histopathology demonstrated transmural necrosis at the perforation margins. No other organ pathology or toxicologic cause was identified. The cause of death was certified as haemorrhagic shock secondary to bowel perforation. This case emphasises the need for caution even with routine paediatric procedures, particularly when involving thermal instruments. It underscores the anatomical vulnerability of infants, the critical need for intraoperative precision, extended postoperative observation and protocol-based care. From a legal standpoint, this case raises questions about informed consent, standard of care and institutional liability. The findings highlight the need for national paediatric surgical safety guidelines, especially regarding electrocautery use in superficial procedures and demonstrate the vital role of forensic pathology in uncovering preventable iatrogenic deaths.<\/jats:p>","DOI":"10.1177\/00258172251405159","type":"journal-article","created":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T05:00:56Z","timestamp":1768798856000},"page":"146-149","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Fatal ileal perforation following umbilical granuloma excision: A medico-legal case analysis"],"prefix":"10.1177","volume":"94","author":[{"given":"Swati","family":"Tyagi","sequence":"first","affiliation":[{"name":"Department of Forensic Medicine and Toxicology, AIIMS, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8677-1989","authenticated-orcid":false,"given":"Gokul","family":"G","sequence":"additional","affiliation":[{"name":"Department of Forensic Medicine and Toxicology, AIIMS, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0040-5821","authenticated-orcid":false,"given":"Benjy Tom","family":"Varughese","sequence":"additional","affiliation":[{"name":"Department of Forensic Medicine and Toxicology, Christian Medical College &amp; Hospital, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3280-4778","authenticated-orcid":false,"given":"Chittaranjan","family":"Behera","sequence":"additional","affiliation":[{"name":"Department of Forensic Medicine and Toxicology, AIIMS, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,1,18]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12186104"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.sempedsurg.2006.10.006"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2016.04.022"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1186\/s43159-020-00029-9"},{"issue":"5","key":"e_1_3_2_6_2","article-title":"Small bowel injury due to electrocautery excision of umbilical granuloma in a four-month-old child","volume":"14","author":"Tayade H","year":"2022","unstructured":"Tayade H, Khedkar K, Lamture Y, et al. Small bowel injury due to electrocautery excision of umbilical granuloma in a four-month-old child. Cureus 2022; 14(5): e24940.","journal-title":"Cureus"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12893-020-00735-6"},{"key":"e_1_3_2_8_2","first-page":"218","article-title":"ICRI White Paper: an update on role of conventional radiography in imaging of pediatric gastrointestinal tract","volume":"33","author":"Jain SN","year":"2022","unstructured":"Jain SN, Shah RS, Modi T, et al. ICRI White Paper: an update on role of conventional radiography in imaging of pediatric gastrointestinal tract. Indian J Radiol Imaging 2022; 33: 218\u2013229.","journal-title":"Indian J Radiol Imaging"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.31729\/jnma.7045"},{"key":"e_1_3_2_10_2","unstructured":"World Health Organization. Safe surgery https:\/\/www.who.int\/teams\/integrated-health-services\/patient-safety\/research\/safe-surgery (2025 accessed 13 June 2025)."},{"key":"e_1_3_2_11_2","first-page":"653","article-title":"Medical negligence and Consumer Protection Act, 2019: judicial response","volume":"6","author":"Mushtaq F","year":"2023","unstructured":"Mushtaq F, Fayaz N. Medical negligence and Consumer Protection Act, 2019: judicial response. Int J Law Manag Humanit 2023; 6: 653\u2013666.","journal-title":"Int J Law Manag Humanit"}],"container-title":["Medico-Legal Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00258172251405159","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/00258172251405159","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00258172251405159","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T06:44:03Z","timestamp":1791441843000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/00258172251405159"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,18]]},"references-count":10,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1177\/00258172251405159"],"URL":"https:\/\/doi.org\/10.1177\/00258172251405159","relation":{},"ISSN":["0025-8172","2042-1834"],"issn-type":[{"value":"0025-8172","type":"print"},{"value":"2042-1834","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,18]]}}}